oiter; 438 fathers and 405 mothers
were not specified.

Sporadic cretinism, or congenital myzedema, is characterized by a
congenital absence of the thyroid, diminutiveness of size, thickness of
neck, shortness of arms and legs, prominence of the abdomen, large size
of the face, thickness of the lips, large and protruding tongue, and
imbecility or idiocy. It is popularly believed that coitus during
intoxication is the cause of this condition. Osler was able to collect
11 or 12 cases in this country. The diagnosis is all-important, as the
treatment by the thyroid extract produces the most noteworthy results.
There are several remarkable recoveries on record, but possibly the
most wonderful is the case of J. P. West of Bellaire, Ohio, the
portraits of which are reproduced in Plate 11. At seventeen months the
child presented the typical appearance of a sporadic cretin. The
astonishing results of six months' treatment with thyroid extract are
shown in the second figure. After a year's treatment the child presents
the appearance of a healthy and well-nourished little girl.

Myxedema proper is a constitutional condition due to the loss of the
function of the thyroid gland. The disease was first described by Sir
William Gull as a cretinoid change, and later by William Ord of London,
who suggested the name. It is characterized clinically by a
myxedematous condition of the subcutaneous tissues and mental failure,
and anatomically by atrophy of the thyroid gland. The symptoms of
myxedema, as given by Ord, are marked increase in the general bulk of
the body, a firm, inelastic swelling of the skin, which does not pit on
pressure; dryness and roughness which tend, with swelling, to
obliterate the lines of expression in the face; imperfect nutrition of
the hair; local tumefaction of the skin and subcutaneous tissues,
particularly in the supraclavicular region. The physiognomy is
remarkably altered; the features are coarse and broad, the lips thick,
the nostrils broad and thick, and the mouth enlarged. There is a
striking slowness of thought and of movement; the memory fails, and
conditions leading to incipient dementia intervene. The functions of
the thoracic and abdominal organs seem to be normal, and death is
generally due to some intercurrent disease, possibly tuberculosis. A
condition akin to myxedema occurs after operative removal of the
thyroid gland.

In a most interesting lecture Brissaud shows the intimate relation
betwe