On sporadic cretinism in America / by William Osler.

  • Osler, William, Sir, 1849-1919.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On sporadic cretinism in America / by William Osler. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    her mouth shut, but sometimes the tongue protrudes between the lips. Thei face is broad, and all the i'eatures thick and coarse. The nose is retroxme,\ the nasal orifices very apparent, and the aim thick, and measure across the* margins fully 5 mm. in thickness. The lips are thick and full; the cheeks* prominent, large, and broad. In the upper jaw the lateral incisors are absent; the central incisors are of fair size, the enamel much eroded ; the canines are i small, also with defective enamel. The premolars and molars are small and j much decayed. In the lower jaw the teeth are all present, but they are- irregular and show the same character of defect. The roof of the mouth is | much vaulted, the palate is not defective. The forehead is full, a little prom- ] inent in front; the head is long; the occiput projects, and it is broad I immediately behind the parietal eminences. The occipital arches are much- developed, and there are thick ridge-like projections at the line of the squamo- parietal sutures. The circumference of the bead is 54i cm.; from the tip oi one ear to the tip of the other, 27 cm.; from the occipital protuberance to the glabella, 38 cm. The ears are well formed. The neck is 36 cm. in circumference. The thyroid gland is distinctly en- larged ; the left lobe more than the right. The hands and arms are well formed ; there is no enlargement of the epiphyses. She uses her fingers well, and can feed herself and pick up small objects, but the movements are some- what clumsy, and she is unable to dress or undress herself. The legs are firm* and strong; not bowed. The gait is as above mentioned; she falls easily, and, as her mother expressed it, has no elasticity. She is flat-footed. The knee-jerk seems slightly increased. The body looks squat and full; the thorax is capacious; the back shows a moderate antero-posterior curvature,; The abdomen is lai'ge. Examination ctf the thoracic and abdominal organs negative. She is well nourished, and the subcutaneous tissues are firm but do no) pit, and there is no appearance like that of myxcedema; it is only in the thickness of the features that the condition is suggested. She talks a great deal; the voice is high-pitched, very difficult to under stand. Some words she speaks clearly, and she talks and behaves very mud as a child of two or three years. She is easily amused ; showed with grea; pleasure and childish joy a little new ring, and is very fond of pretty things She has a very good musical ear; can sing several little songs. She is verj] good-hearted and generous, and always very anxious, if she has anything nice, that the servants, who are devoted to her, should share it. She is, how ever, self-willed, and does not like to be thwarted. She began to menstriiah eighteen months ago. Case III. (Dr. Booker.)—Minnie R., white, aged three and one-half years) came to Johns Hopkins Hospital Dispensary November 25, 1892. She wa f born in Lebanon, Pa., and lived there until one year ago, when she was movec i to Steelton, Md. Born in natural labor; mother had only three har( pains; was a fat, healthy child up to second summer; when oue year old had summer diarrhoea, about sixteen stools daily for a month; after that th- bowels became regular, and the child improved for a short while, then begai to waste again without anything to account for it. She had no cough, n‘; fever. There appears to have been no growth and no improvement sine- the attack of diarrhoea at one year of age, excepting the slight improvemen _