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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    j as it relates to the United States and Canada, and upon inquiries made ]. of the superintendents of the Asylums for the Insane and of Institu- j tions for Feeble-minded Children throughout the country, as well as of many friends. As much misunderstanding exists as to the exact definition of a cretin, illustrated by the fact that at least one-half of the photographs j sent me from different institutions did not belong to this type of idiocy, f it may be well to define somewhat carefully the precise conditions to which this term should be applied. In the first place, there is no essen-1 tial difference between the cases occurring in large numbers in goitrous ! districts and the sporadic cases. The term should be limited accurately - to a form of idiocy associated with changes in or absence of the thyroid i gland. The following statements are based upon the recent article of ; Horsley.’ The important factor is the loss of the function of the- 3 thyroid gland, whether this results from congenital defect, progressive- i atrophy, or coarse changes which gradually annul its function. 1. Congenital cretinism is rare, and is usually associated with absence- : of the thyroid gland. The child rarely lives, but the changes presented.^ are sufficiently distinctive for diagnosis. The supra-clavicular fatty t tumors are well marked and the skin generally is thick and in folds. The limbs are short, the epiphyses swollen, while the shafts are much'ii ossified. The skull is broad and short, the sutures open, and the basi- ! sphenoid junction is prematurely ossified, a point upon which Virchow - laid great stress. This congenital variety maybe difficult to distinguishi,.; from rickets. Degenerative changes, slow over-growth of the fibrous 3 tissue, and a myxoedematous condition have also been met with. 2. Ante-natal and subsequent slow development of cretinism. Here t the changes appear to have been initiated during foetal life, but are. ! slight and scarcely noticeable at birth. “ The infant shows no, or very 3 slight, signs of intelligence, but the physical signs are less obvious. 1 According to some, the majority at birth have a goitre, usually of about ) an inch in diameter; the body is large, with disproportionate head and i hands, and, what is more important still in connection with the similarity ' to myxoedema, in many cases the subcutaneous tissues appear oedema- f tous; occasionally, according to the severity of the case, there is also 1 non-development of the facial bones, a flattened nose, giving a stupid 1 appearance, and a large thick tongue. The neck is short and thick. • It is obvious that under these circumstances we have the same condition I as that described above, only much less severe; the further history of ' these cases shows that the destruction of the thyroid gland continues, and the symptoms develop into the worst form of cretinism, about to be described.” (Horsley.) 1 Tuke's Dictionary of Psychological Medicine ; art. “ Cretinism.”