“ In young adolescents it may be so rapid that the patient has to be kept lying down to prevent permanent bending of the long bones of the leg, softened by their rapid growth. A very typical case under Dr Hector Mackenzie, showing what can be expected from early treatment, is that of a cretin aged 11 years in 1893, when thyroid treatment was started. ”

“ Even small doses, if beyond the patient’s power, may produce fever, excitement, headache, insomnia and vomiting. The administration must be persisted in throughout life, otherwise myxoedematous symptoms appear. The first most apparent results are those of growth, and this may supervene even in patients up to 25-30 years of age. Once started, 4 to 6 in. may be gained in stature in the first year’s treatment, though this is usually in inverse ratio to the age of the patient, and also diminishes in later stages of treatment. ”

“ Some years later a certain power of movement is acquired, but the gait is waddling and clumsy. Speech is long delayed, or in bad cases may be almost entirely lacking. The voice is usually harsh and unpleasant. ”

“ Of the senses smell and taste are but slightly developed, more or less deafness is generally present, and only the sight is fairly normal. In the adult the genital organs remain undeveloped. If the cretin is untreated he rarely has a long life, thirty years being an exceptional age. Death results from some intercurrent disease. ”

“ The mental capacity varies within narrow limits; an intelligent adult cretin may reach the intellectual development of a child 3-4 years of age, though more often the standard attained is even below this. The child cretin learns neither to walk nor talk at the usual time. Often it is unable even to sit without support. ”