This gradually
extended to the shoulders, and was attended with some uncertainty
of tactile sense and clumsiness of movement, but actual
anesthesia had never been demonstrated. This numbness had not
invaded the trunk or lower extremities, although there was slight
uncertainty in the gait. There had been a slowly progressing
enlargement of the head, face, and neck, affecting the bone,
skin, and subcutaneous tissues, the first to the greatest degree.
The circumference of the neck was 16 inches; the horizontal
circumference of the head was 24 inches; from ear to ear, over
the vertex, 16 inches; and from the root of the nose to the
occipital protuberance, 16 inches. The cervical vertebrae were
involved, and the woman had lost five inches in height. It may be
mentioned here that Brissaud and Meige noticed the same loss in
height, only more pronounced, in a case of gigantism, the loss
being more than 15 inches. In Starr's case the tongue was normal
and there was no swelling of the thyroid.
Cretinism is an endemic disease among mountainous people who
drink largely of lime water, and is characterized by a condition
of physical, physiologic, and mental degeneracy and
nondevelopment, and possibly goiter.
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