seven
years old, then the slow development is noticed. The tongue looks large
and hangs out of the mouth. The hair may be thin, the skin very dry.
Usually by the end of the first year and during the second year the signs
of the cretinism become very marked and should be recognized. The face
looks large, looks bloated, the eyelids are puffy and swollen, the nose is
flat and depressed and thick. Teething is late, and the teeth that do
appear decay. The fontanelles are open. The abdomen is swollen, the legs
are short and thick, the hands and feet are not developed and look pudgy.
The face is pale and has a waxy, sallow tint. The muscles are weak and the
child cannot support itself. Above the collar bone there are pads of fat.
The child does not develop mentally and there may be one of the grades of
idiocy and imbecility (feeble-minded).

[BLOOD AND DUCTLESS GLANDS 261]

(b) Myxoedema, proper--The skin is infiltrated, causing loss of the lines
of the facial expression, skin is dry and harsh, much thickened,
especially in the region above the collar bone. The face is broad, with
coarse features, the nose is broad and thick, the mouth is large, lips
thick, hair scanty and coarse, slowness of motion and thought, weak
memory, irritability, headache, suspiciousness, followed sometimes by
hallucinations, delusion and dementia (insane). The disease may progress
for ten or fifteen years. Death may occur early.

Operative type.--This rarely develops except the thyroid glands have been
entirely removed and then only if no extra glands are present.

Symptoms.--Are the same as that of cretinism.

Treatment.--An even, warm climate. Thyroid extract, to be given by a
physician, is the remedy. After the recovery occasional small doses still
may be necessary for some, or in cretinism for life.

DISEASES OF THE NERVOUS SYSTEM.

NEURALGIA.--Pain occurring in the course of the nerves and in their area
of distribution. The pain has remission and intermissions, and is due to
some morbid affection of the nerves of sensation or their spinal or
(brain) centers.

Causes.--The affection may depend upon some functional disturbance alone;
or it may be due to some organic disease of the nerve or to some disease
or diseased state outside of the nervous system. It occurs more frequently
in women past the middle-age, in those of a nervous tendency. As stated,
it affects women more than men. Debility is a frequent cause. Neuralgia is
frequent