Sporadic cretinism. [ Reprinted from the Philadelphia Hospital Reports for 1892. 
A CASE OF SPORADIC CRETINISM. 
F. X. DERCUM, M.D. 
Cases of cretinism are always interesting, especially in this 
country, where the disease is so infrequently met with. Further, 
it is not improbable that the disease is, in the less typical cases, 
every now and then mistaken for rachitis, and vice versa. The 
study of the following case will therefore he of some value. 
Cases in which the individual remains during his entire life in- 
fantile, both in size and in mental development, are very easy of 
recognition. Such, for instance, is the case of little “ Bartie M.,” 
who is so familiar to the visitors of the Philadelphia Hospital, 
and is at present under the care of my colleague, Dr. Mills. It is, 
however, in the cases in which a greater development, both physi- 
cally and mentally, takes place, that the stunted growth is likely to 
be attributed to rickets. 
In the case before us (see cut), the past history is derived from 
a rather unsatisfactory source,—the patient himself. It is brief 
and of doubtful value. 
"W. H., male, gives his age at one time as thirty-five, at another as forty-seven. 
Says that he was born in Philadelphia, and when asked his occupation says that he 
has “helped a huckster.” He cannot give the nativity of his father or mother. 
Says that both are dead ; says that he has three brothers and a sister, and that they 
are strong and well, likewise asserting the same of himself. 
Further, he tells us that he had the dropsy when a little hoy, and also the 
chicken-pox, which he claims destroyed his left eye. States also that he has never 
been in the hospital before, though this is clearly the fourth time that he has made 
his appearance. 
He was admitted to the out-wards twTo weeks previous to his admission to the 
nervous department. He stated that he had been “ kicked by a horse in the stomach,” 
that his stomach had “ swelled out,” and that he had been unable to pass his water. 
This story was doubted, as he presented absolutely no symptoms of injury, had no 
pain, and was apparently quite comfortable in every way. 
The following physical peculiarities were noted : In stature he was decidedly 
dwarfed, being but four feet five inches in height. The trunk was relatively long, 
the limbs—more especially the thighs—being relatively short. The chest is broad 2 
A CASE OF SPORADIC CRETINISM. 
and flat, the abdomen large, relaxed, and distended. The forearms and legs are 
thick. The distal ends of the bones in both legs are distinctly enlarged. The 
hands are unusually broad and the fingers thick. The feet are broad and quite flat. 
His gait is peculiar in that the feet are raised with a side-wise swing, and that there 
is an awkward rocking to and fro as he walks. The nails also are quite broad and 
flat. 
The head is large ; the face broad, especially across the malar region ; the hair is 
a dark brown, dense and thick, and grows low down over the forehead. The eyes 
are widely separated ; the nose is short; the root of the nose being much depressed, 
while its end is broad, flattened, and much turned up. The cheek-bones are large 
and prominent, while the jaw is short, small, and relatively undeveloped. 
The face is much wrinkled, being marked by transverse furrows across the brow, 
by deep creases below the eyes and over the malar hones, and to either side of the 
alee of the nose and mouth. As a whole, the face looks cedematous and putfy, while 
its color is a dirty yellowish white. The ears are large and stand out from the head 
to an unusual degree. 
The neck is thick, putfy, and excessively wrinkled where it joins the skin about 
the jaw. Above either clavicle is found a soft swelling, more marked on the right 
side. No thyroid gland can be felt. 
The back presents in the lumbar region an excessive lordosis. In addition to 
the anterior curvature there is also a slight flexion to the left. The left shoulder is 
slightly lower than the right. 
The skin as a whole is of a dirty yellowish hue, and everywhere, especially in 
the small of the back, in the neighborhood of the joints and over the hands, is ex- 
cessively wrinkled. It feels harsh, dry, very rough, and thick. In some places, 
as over the hands and forehead, it feels as though loosely attached to the parts 
below ; at others, as over the chest, abdomen, and thighs, a soft subdermal tissue 
appears to be present. 
There is a small moustache, and the genitalia appear well developed. Inquiries 
as to sexual power resulted negatively. 
The muscles appeared fairly developed, while the knee-jerks were slightly exag- 
gerated. 
Mentally the patient is at the level of a middle-grade idiot. Thought and ap- 
prehension are very slow. His speech is thick and likewise slow. The consonants 
are not distinctly enunciated, and the intonation, as a whole, resembles that of a 
young boy. In early life an attempt appears to have been made to teach him to 
read and write, but it was evidently unsuccessful.