. The thyroid gland in health and disease. ype of Cretinism.—Fig. 59 shows atypical cretin of the myxoedematous type. The failure ofskeletal growth and the arrest of the process of ossificationresults in dwarfism and skeletal deformities of various kinds.The bones are short and thick ; rachitic curving of the tibiais almost invariable ; the epiphyses persist and the fontanellesremain open. The cheek bones are prominent, the root of thenose retracted, the forehead low ; the skull varies considerablybut is usually larger in proportion than the rest of the skeleton. MYXCEDEMATOUS TYPE OF CRETINIS
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. The thyroid gland in health and disease. ype of Cretinism.—Fig. 59 shows atypical cretin of the myxoedematous type. The failure ofskeletal growth and the arrest of the process of ossificationresults in dwarfism and skeletal deformities of various kinds.The bones are short and thick ; rachitic curving of the tibiais almost invariable ; the epiphyses persist and the fontanellesremain open. The cheek bones are prominent, the root of thenose retracted, the forehead low ; the skull varies considerablybut is usually larger in proportion than the rest of the skeleton. MYXCEDEMATOUS TYPE OF CRETINISM 135 Relaxation and infiltration of the ligamentous structures of thebody may give rise to knock-knee, fiat-foot and varying gradesof spinal curvature (fig. 60 ; compare fig. 34). The infantilecondition of the sex organs persists, the failure of their develop-ment further depriving the body of the stimulus to physicaland mental growth which their functional activity affords.Undescended testicle is common. There is a lack of development. J.V^0l^^^^ Fig. 59.—•Typical cretin. (From a photograph in the possession of the lateSir Victor Horsley, F.R.S.) of all intellectual and sense functions. Mental torpor is marked ;all cretins are idiotic or imbecile in greater or lesser degree ; theyare commonly deaf-mute or mute, or their powers of hearing andspeech are defective ; they sleep heavily and are not easifyroused. Cutaneous sensibility is impaired and burns and woundsheal badly. The excreta may be passed under them. Themuscular system is ill-developed and lacks tone ; the head fallsforward on the body ; the abdomen protrudes, due partly to 136 ENDEMIC CRETINISM muscular relaxation, partly to the disproportionate size of theabdominal organs to the skeleton. Hernias of the umbilicusand other orifices are common. The umbilicus is usually everted(fig. 60). The child supports himself with difficulty—and if itmoves at all it crawls about in a sluggish way on its handsand knees, or
