beyond the mouth at all
times, and interfering with breathing, when the infant is in a
recumbent position.

More and more of the characteristics of the affection turn up. The
queer, repulsive, pitiful face of the cretins, which makes them all
seem brothers or twins, shapes itself. A yellowish, white or waxy
pallor; rough, dry, scaly, bloated skin; swollen, often wrinkled brow;
watery eyes, often almost concealed by the thickened eyelids; the
depressed pug nose with its wide, thick nostrils; large, erect ears;
the wobbly, drooling tongue, sticking out at one, yet not in derision;
the hair thin, and like tow in texture rather than human; eyebrows
and eyelashes are scant, and often absent; the nails short, thin and
brittle; the teeth, very late in coming, may be represented by a few
sharp points, irregular, decaying quickly, sometimes not succeeded at
all by those of the second dentition.

Whatever growth occurs is irregular and disproportionate. The trunk,
though small compared with the head, appears massive against the
background of the diminutive extremities. The back is somewhat humped,
arching at the waist-line, while the abdomen protrudes like a balloon,
with a hernia, often, at the navel. The extremities are short, bowed,
cold, and livid, covered with rolls of the infiltrated skin, rolls
which cannot be smoothed out. Hands and feet are broad, pudgy, and
floppy, the fingers stiff, square and spade-like, the toes spread
apart, like a duck's, by the solid skin. Above the collar bones there
are frequently great pads of fat which sometimes encircle the narrow
bull neck.

The mental state varies with the degree of deprivation of the internal
secretion of the thyroid. In the worst cases it is repulsively
vegetable. Even the intelligence common to the higher animals is
wanting. The cretins of the "human plant" kind, as they have been
nicknamed, will not recognize mother or father or any person about
them, or even a person from an object, and manifest no interest in
anything or anybody, not even toys. Hunger and thirst they manifest by
grunts and inarticulate sounds, or by screaming. They neither smile,
cough, nor laugh, but sit like sphinxes, breathing, but not reacting.

There are, of course, all grades and varieties. There are those who
recognize parents and familiar faces, and exhibit some evidence of
affection for them, acquire a limited vocabulary, and then cease, no
progress possible even with the alphabet. They