HYPOTHYROIDISM 



401 



to myxedema, but this is also due to the stooped carriage of the head, 

 from muscle weakness. The neck may be goitrously deformed. 



Such affected children have not enough intelligence for play. If they 

 can walk, they waddle awkwardly about or more often sit listlessly star- 

 ing in blank fixity. When irritated, they may bellow strangely. When 

 pleased they exhibit that sudden characteristic grin which Garrod has 



I 



i 



B 



Fig. 6. Cretinism with Idiocy, female, aged 23. Note characteristic smile and 

 pot-belly. (N. W. Janney, original observation.) 



emphasized. An exaggerated tendency to sleep is frequently present. 

 Their personal habits are uncleanly. 



Typical Hypothyroidism in the Adult. Myxedema. The develop- 

 ment of the disease in the adult usually is that of a slowly appearing 

 cachexia. General malaise, weakness, loss of memory and mental irrita- 

 bility or hebetude, drowsiness, lack of concentration are among the first 

 mptoms to appear. Gain of weight rapidly ensues with appearance of 

 yxedematous deposits. The change from health may ensue so gradually 



