THE THYROID AND PARATHYROIDS 



285 



described that it is unnecessary to make more than a brief 

 reference to some of them. The changes in the skin are stated 

 by many observers to be identical with those found in myxce- 

 dema. 



McCarrison states that in the Chitral and Gilgit Valleys there 

 are two distinct 

 types of the 

 disease (1) the 

 myxoedema t o u s 

 type, and (2) the 

 nervous type. 

 Cases commonly 

 present the clini- 

 cal features of a 

 combination o f 

 these. Deaf- 

 mutism is an 

 almost constant 

 accompani m e n t 

 of both types of 

 the disease. The 

 myxoedema t o u s 

 type corresponds 

 with the form 

 met with in 

 Europe. 



The nervous 

 cretins are help- 

 less, and usually 

 deaf and dumb. 

 There is a 

 "knock -kneed" 

 spasticity of the 

 lower limbs, in- 

 creased knee- 



jerk, and there may be marked flexion of the toes on 

 the sole. The upper limbs assume a position of right-angled 

 flexion ; the thumb may be drawn into the palm and the fingers, 

 closed over it, whilst the wrist is flexed. Among other nervous 

 symptoms are movements of the head, grimaces, convulsions, 

 nystagmus, and internal strabismus, and idiocy, It is impor- 



FIG. 84. Cretin after treatment. February, 1899. 

 Height 38 in. (From Murray.) 



