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CRETINISM
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CRETINISM , the See also:term given to a chronic disease, either sporadic or endemic, arising in See also:early childhood, and due to' See also:absence or deficiency of the normal secretion of the See also:thyroid gland. It is characterized by imperfect development both of mind and See also:body. The thyroid gland is either congenitally absent, imperfectly See also:developed, or there is definite See also:goitre. The origin of the word is doubtful. Its See also:southern See also:French See also:form Chrestiaa suggested to See also:Michel a derivation from cresta (See also:crete), the See also:goose See also:foot of red See also:cloth worn by the See also:Cagots of the See also:Pyrenees. The Cagots, however, were not cretins. The word is usually explained as derived from chretien (See also:Christian) in the sense of "See also:innocent." But Christianus (which appears in the Lombard cristanei; compare the Savoyard innocents and gens du bon dieu) is probably a See also:translation of the older cretin, and the latter is probably connected with creta (eraie)—a sallow or yellow-earthy complexion being a See also:common See also:mark of cretinism. The endemic form of cretinism prevails in certain districts, as in the valleys of central See also:Switzerland, See also:Tirol and the Pyrenees. In the See also:United See also:Kingdom cretins have been found in See also:England at See also:Oldham, Sholver See also:Moor, See also:Crompton, Duffield, Cromford (near See also:Matlock), and other points in See also:Derbyshire; endemic goitre has been seen near See also:Nottingham, See also:Chesterfield, See also:Pontefract, See also:Ripon, and the mountainous parts of See also:Staffordshire and See also:Yorkshire, the See also:east of See also:Cumberland, certain parts of See also:Worcester, See also:Warwick, See also:Cheshire, See also:Monmouth, and See also:Leicester, near See also:Horsham in See also:Hampshire, near See also:Haslemere in See also:Surrey, and near See also:Beaconsfield in See also:Buckingham. There are cretins at Chiselborough in See also:Somerset. In See also:Scotland cretins and cases of goitre have been seen in See also:Perthshire, on the east See also:coast of See also:Fife, in Roxburgh, the upper portions of See also:Peebles and See also:Selkirk, near See also:Lanark and See also:Dumfries, in the east of See also:Ayrshire, in the See also:west of See also:Berwick, the east of See also:Wigtown, and in See also:Kirkcudbright. The disease is not confined to See also:Europe, but occurs in See also:North and See also:South See also:America, See also:Australia, See also:Africa and See also:Asia. Wherever endemic goitre is See also:present, endemic cretinism is present also, and it has been constantly observed that when a new See also:family moves into a goitrous See also:district, goitre appears in the first See also:generation, cretinism in the second. The See also:causation of goitre has now been shown tobe due to drinking certain See also:waters, though the particular impurity in the See also:water which gives rise to this See also:condition has not been determined (see GOITRE). The causation of the sporadic form of cretinism is, however, obscure. Cretinism usually remains unrecognized until the See also:child reaches some eighteen months or two years, when its lack of See also:mental development and uncouth bodily form begin to attract See also:attention. Occasionally the child appears to be normal in See also:infancy, but the cretinoid condition develops later, any See also:time up to See also:puberty. The essential point in the morbid See also:anatomy of these cases is the absence or abnormal condition of the thyroid gland (see METABOLIC DISEASES). It may be congenitally absent, atrophied, or the seat of a goitre, though this last condition is very rare in cases of sporadic cretinism. The See also:skeleton shows arrested growth, most marked in the See also:case of the See also:long bones. The See also:skull in the endemic form of cretinism is usually See also:brachycephalic, but in the sporadic cases it is more commonly See also:dolichocephalic. The See also:pathology of cretinism and its allied condition myxoedcma (q.v.) has now been conclusively worked out, and its essential cause has been shown to be loss of See also:function of the thyroid gland. The condition has existed and been described in far back ages, but mingled with so many other entirely different deformities and degenerations that it is now often almost impossible to classify them satisfactorily. The following is a vivid picture by Beaupre (Dissertation sur See also:les cretins, translated in See also:Blackie on Cretinism, Edin., 1855): " I see a See also:head of unusual form and See also:size, a squat and bloated figure, a stupid look, bleared hollow and heavy eyes, thick projecting eyelids, and a See also:flat See also:nose. His See also:face is of a leaden See also:hue, his skin dirty, flabby, covered with tetters, and his thick See also:tongue hangs down over his moist livid lips. His mouth, always open and full of saliva, shows See also:teeth going to decay. His See also:chest is narrow, his back curved, his breath asthmatic, his limbs See also:short, misshapen, without See also:power. The knees are thick and inclined inward, the feet flat. The large head drops listlessly on the See also:breast; the See also:abdomen is like a bag." When fully grown the height rarely exceeds 4 ft., and is often less than 3 ft. The skin feels doughy from thickening of the sub-cutaneous tissues, and it hangs in folds over the abdomen and the bends of the See also:joints. Very frequently there is an umbilical See also:hernia. The See also:hair has a far greater resemblance to See also:horse-hair than to that of a human being, and is usually absent on the body of an adult cretin. The temperature is subnormal, and the exposed parts tend to become See also:blue in See also:cold See also:weather. The See also:blood is usually deficient in haemoglobin, which is often only 40-50 % of the normal. The mental capacity varies within narrow limits; an intelligent adult cretin may reach the intellectual development of a child 3-4 years of See also:age, though more often the See also:standard attained is even below this. The child cretin learns neither to walk nor talk at the usual time. Often it is unable even to sit without support. Some years later a certain power of See also:movement is acquired, but the gait is waddling and clumsy. Speech is long delayed, or in See also:bad cases may be almost entirely lacking. The See also:voice is usually harsh and unpleasant. Of the senses See also:smell and See also:taste are but slightly developed, more or less deafness is generally present, and only the sight is fairly normal. In the adult the genital See also:organs remain undeveloped. If the cretin is untreated he rarely has a long See also:life, See also:thirty years being an exceptional age. See also:Death results from some intercurrent disease;
Cretinism has to be distinguished from the See also:state of a Mongolian idiot, in whom there is no thickening of the subcutaneous tissues, and much greater alertness of mind; from achondroplasia, in which condition there is usually no mental impairment; and from infantilism, which covers a See also:group of symptoms whose only common point is that the See also:primary and secondary sexual characteristics fail to appear at the proper time.
Before 1891 there was no treatment for this disease. The patients lived in hopeless imbecility until their death. But in that See also:year Dr See also:George See also: L. See also:Fox of See also:Plymouth, and Howitz of See also:Copenhagen, each working independently, showed the equally potent effect of,the gland administered by the mouth. The remedy was See also:soot) after applied to cretinism and its effects were found to be even more wonderful. It has to be used, however, with the greatest care and discrimination, since See also:personal See also:idiosyncrasy seems to be to very variable See also:factor. Even small doses, if beyond the patient's power, may produce See also:fever, excitefnent, headache, See also:insomnia and vomiting. The See also:administration must be persisted in throughout life, otherwise myxoedematous symptoms appear. The first most apparent results are those of growth, and this may supervene even in patients up to 25-30 years of age. Once started, 4 to 6 in. may be gained in stature in the first year's treatment, though this is usually in inverse ratio to the age of the patient, and also diminishes in later stages of treatment. In See also:young adolescents it may be so rapid that the patient has to be kept lying down to prevent permanent bending of the long bones of the See also:leg, softened by their rapid growth. A very typical case under Dr Hector Mackenzie, showing what can be expected from early treatment, is that of a cretin aged 11 years in 1893, when thyroid treatment was started. He See also:grew very rapidly and became a normal child, passed through school, and in 1908 was at one of the See also:universities. Uber Cretinismus," Wurzburger Verhand. ; Hector Mackenzie, " Organotherapy," Textbook of See also:Pharmacology and See also:Therapeutics (1901) ; Weygandt, Der heutige Stand der Lehre vom Kretinismus (See also:Halle, 1903) ; Hector Mackenzie, " Cretinism," Allbutt & Rolleston's See also:System of See also:Medicine, See also:part iv. (1908). Additional information and CommentsThere are no comments yet for this article.
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