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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    3 Development of cretinism in early childhood. The infant may be perfectly normal at birth, develop naturally, and show no signs of disease until from the second to the fifth year. A majority of the in- stances of sporadic cretinism belong to this division. “The child from jeing bright and normal becomes gradually less and less intelligent, and it the same time the physical appearances which have been summed up in the conditions before mentioned begin to assert themselves. The child does not increase in height, the limbs similarly do not lengthen, but remain short and thick. The trunk is broad and thick, there being il«o well-marked lordosis, so that the abdomen is prominent. In like manner the neck is shortened, the skull broad, the nose retrousse, the ips thick, and the teeth very imperfectly developed. The speech, from 3cing clear becomes thick, the voice is rough and at times stridplous, the physiognomy is placid to stupidity, the skin is coarse, the hair be- comes scanty and thin. There is well-marked anaemia; the subcuta- neous tissues have a peculiar kind of spongy or waxy feel, as if there were, so to speak, solid oedema occupying the connective fibres of the tissues. “ The condition thus produced reaches its height usually by the end of fourteen or fifteen years, so that by the twentieth or twenty-first year it has attained complete development, and thenceforward remains perfectly stationary until death. Hence, at the age of thirty the physical appear- ance presented is that of a young child, and the intellectual condition similarly does not advance beyond that of childhood.” (Horsley.) A majority of the cases of which I shall speak and which are illustrated in this paper belong in this division. The adult condition of cretinism as seen in cases which have devel- oped slowly, and have reached the age between twenty or thirty and over, is very characteristic. This “ pariah of Nature, as it has been ! called, is a being degenerate both physically and intellectually; short in stature and childish in appearance. The height usually does not 1 exceed that of a child from five to seven years old. The skm is often rough, sometimes brown and stained, but in the sporadic cases moie i frequently of a chalky earthy hue. In certain instances the subcuta- ■ neous tissues are much infiltrated, so that the skin has a curiously waxy . hue. Supra clavicular folds of a fatty and myxoedematous character are common. The hair may be thick, and is usually confined to the head, even in adults ; but in some instances there are traces in the axillse and on the pubes. The face has an aspect of dulness and stu- pidity, though sometimes in the sporadic cases it is bright and smiling. The lips are broad and thick and prominent; the nose is broad at the base ; the nostrils wide; the aim very broad and pass without any special division into the naso-labial fold. The eyes are widely separated and sometimes present strabismus. The eyelids are often cedematous. In