Fig. 33.—An example of myxedematous infantilism.
Fig. 34.—A group of cretins in the valley of Aosta (Piedmont). The alteration of the thyroid gland is of endemic origin.
Renato L.,[31] age twenty-nine; stature 1.30 m. (average stature at the age of ten, 1.28 m.; at eleven, 1.32 m.) weight, 32 kilograms (average weight, age of twelve, 31 k.). It appears from his history that he developed normally up to the age of nine, after which period an arrest of development occurred, both physical and psychic. An arrest of the genital organs dates back also to early childhood. His intelligence is that of a backward child; he has never been able to read or write, but can count up to 1000. He has never been able to learn a trade, but shows some talent for drawing.
His criminal instincts seem to be especially developed. He spends whole hours, turning over the leaves of popular illustrated novels, and whenever he comes across a picture representing a homicide or an assassination, he utters loud exclamations of delight. He has only one passion, tobacco, and only one object of adoration, Ravachol. Very violent, extremely irritable; when he is angry, he would kill someone, if, as he says, "he had the strength for it." Although, as a rule, he docilely obeys the orders given him, it is because he is "afraid of being scolded." His ideal is to be able some time to obtain refuge in the Hospice de Bicêtre.
From De Sanctis's work, Gli Infantilismi, I obtain the following data, that are very suggestive on the anthropological side, regarding a case of infantilism observed by the professor in his asylum-school for defective children, in Rome.
Vincenzo P., seven years of age. Father in good health and of good character. Mother small, thin, weak, underfed; has had nine children, of which five are living, all feeble. Vincenzo was born in due time, birth regular; had five wet-nurses; cut his teeth at the normal intervals; began to walk at the end of the second year and to speak at the end of the first. According to his mother, all went well until the fourth year. At this period, Vincenzo became very troublesome and ceased to "grow taller." Later on he was sent to the communal school, but the director of the school in the Via Ricasoli, seeing how undersized and backward he was, sent him to the Asylum-School for defective children.
In appearance the child is eurhythmic, excepting that the head appears a little too big in proportion to the rest of his body; but it is not of the hydrocephalic type (an infantile characteristic). He is slightly asymmetric, the postero-inferior portion of the right parietal bone being more depressed than that of the left (infantile plagiocephaly).
Measurements
Age at which the Vincenzo would be normal
Of the child
Normal measurements at the age of seven
Stature, 0.870 m.
1.10 m.
Three years, stature, 0.864 m.
Weight, 12.400 kg.
20.16 kg.
Two years, weight, 12 kg.
Circumference of chest, 0.507 m.
0.55 m.
Four years, circumference of chest, 0.505 m.
Vital index, 59
Vital index, 54
Two years, vital index, 59.
The bust is greatly developed in comparison with the lower limbs, which are unquestionably short. (The sitting stature was not taken, but this note, recorded from simple observation, reminds us of the enormous difference between the indices of stature at the age of two or three and at the age of seven: Index at two years=63; at three=62; at seven=56.)
But although we lack the index of stature, we may make use of the vital index, which is given by the proportion between the circumference of the chest and the stature, and consequently gives us an index of the morphology of the bust in its relation to the whole personality; thus we find that the vital index corresponds in the present case to that of a child of two, as is also true of the weight, so that we may deduce that the index of stature was probably about 62-63.
He shows no impairment as to external sensations; on the other hand, internal sensations, such as satiety, illness, etc., are blunted. His power of attention seems sufficient, both at play and in school and when questioned. Neither does his memory show anything abnormal. Emotionally, he is below the normal level; he says that he is afraid of thunder; occasionally he shows annoyance when disturbed; but it is equally certain that he never becomes angry, never turns pale and never blushes, as the result of any excitement. He is of an indifferent disposition and is passive in manner; he is good natured, or rather, a certain degree of apathy makes him appear so.
All things considered, his mental development may be described as that of a three-year-old child; only that he differs from children of that age in his lack of vivacity and in his complete development of articulate speech (it should be noted, in regard to the diagnosis of age made by so distinguished a psychologist as De Sanctis, that he judged the child to have a psychic development corresponding to the age of three years); while we, studying the general measurements of the body, determined that they correspond to three different ages, namely, two, three and four the average of which is precisely three; while the stature, which is the index of development of the body as a whole, corresponds almost exactly to that average of three years (0.870 m., 0.864 m.).
Pathogenesis of Infantilism.—At this point it might be asked: Why do we grow? We hide the mechanism of growth under very vague expressions: biological final causes, ontogenetic evolution, heredity. But, if we stop to think, such expressions are not greatly different from those which they have replaced: the divine purpose, creation.
In other words, a causal explanation is lacking. But positive science refuses to lose itself in the search after final causes, in which case it would become metaphysical philosophy. Nevertheless, it may pursue its investigations into the genesis of phenomena, whenever the results of experiments permit it to advance.
So it is in the case of growth; certain relatively recent discoveries in physiology have made it possible to establish relations between the development of the individual and the functions of certain little glands of "internal secretion." Now, the discovery of these relations is certainly not a causal explanation of the phenomenon of growth, but only a profounder analysis of it.
Hitherto, we have considered the organism in regard to its chief visceral functions: in speaking of macroscelia and of brachyscelia, we considered the different types in relation to the development of the organs of vegetative life and the organs of external relations: the central nervous system, the lungs, the heart, the digestive system. Our next step is to enter upon the study of certain little organs, which were still almost ignored by the anatomy and physiology of yesterday. These organs are glands which, unlike other glands (the salivary glands, the pancreas, the sudoriferous glands, etc.), are lacking in an excretory duct, through which the juices prepared for an immediate physiological purpose might be given forth; and in the absence of such excretory tubes, their product must be distributed through the lymphatic system, and hence imperceptibly conveyed throughout the whole organism.
One of these glands, the one best known, is the thyroid; but there are others, such, for example, as the thymus, situated beneath the sternum, or breast-bone, and much reduced in size in the adult; the pineal gland or hypophysis cerebri, situated at the base of the encephalon; the suprarenal capsules, little ear-shaped organs located above the kidneys. Up to a short time ago, it was not known what the functions of such glands were; some of them were regarded as atavistic survivals, because they are more developed in the lower animals than in man, and consequently were classed with the vermiform appendix as relics of organs which had served their functions in a bygone phylogenetic epoch and remain in man without any function, but on the contrary represent a danger through the local diseases that they may develop. The cerebral hypophysis was in ancient times regarded as the
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