_Symptoms_—The symptoms are practically identical with those of the myxoedema which follows the removal of the thyroid gland in adults. The symptoms of cretinism in most cases in infants make their appearance during the first year, occasionally, however, not until the child is three or four years of age. The appearance of the cretin is very striking, and so characteristic that when once seen the disease can hardly fail to be recognized. The child is much dwarfed, the fingers and toes are short and stumpy, the cutaneous tissues seem to be thick and boggy, but do not pit on pressure, as in ordinary oedema. The facies is extremely characteristic. The head seems large for the body, the fontanel is open until the eighth or tenth year, the forehead is low and the base of the nose broad, so that the eyes seem unusually wide apart. The lips are thick, the mouth half open and the tongue protrudes slightly, the cheeks are baggy and the hair is coarse, short and straight, and the skin has the peculiar leathery feel of elephant skin. The abdomen is pendulous, large, streaked with prominent veins, and reminds one of rickets. The skin is dry, the voice husky and rough. There is but one word which describes the peculiar clumsy manner of walking—that word is waddle. The child actually waddles like a duck. The temperature is always subnormal, and one of the things the mother will always call to your attention is the fact that the child has such cold hands and feet and requires so much more cover than the other children. Cretins are dull, placid and good natured, never quarrelsome.
_Treatment_—There is no tendency toward spontaneous improvement. These cases have until the last few years been considered hopeless and condemned to a life of idiocy. Really, in the treatment of cretinism in the adult marvelous results have been got from the administration of the dried and dessicated extract of the thyroid gland of the sheep. This has led to its use in the myxoedema of infancy. The results are astounding. The child grows mentally and physically, takes note of surroundings to which it formerly paid no attention whatever, and can be taught almost as well as a perfectly normal child. In all cases the thyroid extract must be kept up indefinitely, the dose being gradually increased, otherwise the improvement ceases at once.