TRUE CRETINISM This affection is dependent upon total atrophy of the thyroid, or on the obliteration of the last portion of tissue capable of secretion in a strumously degenerated thyroid. At the same time it is the expression of ft hostile influence prevailing in certain regions and families, where it has made its ravages for generations. Endemic cretinism is in all respects homogeneous to acquired athyrcosis and,like t he latter, is a deuteropathic manifestation of the absence of thyroid secretion, although in some individuals, degenerated by the inheritance of generations, this form is unusually severe.
Thus, clinical, anatomical and physiological manifestations of absent function in endemic and sporadic cretinism agree with each other in the widest sense; they are amenable to the same treatment and to no other; both forms, as we shall see later on, may be observed as incomplete pathological pictures or Ionizes Irustes.
At this juncture we have only to examine into the essential differences. Endemic cretinism is confined to certain goitre regions (Franken, Berne Upper District, Wallis, Savoya, Aosta Valley, Salzburg, Styria, Carinthia, certain valleys of the Vosges mountains, of the Black Forest, the IIarz and Neckar).
Where goitre and eretinism have occurred for several generations in goitre regions (Magnus-Levy, Weygandt) the drinking-water plays a part. This was already known to Pliny and has been confirmed by Kocher's masterly investigations. A causative factor which could be de.stroyed by boiling (Lustig) has not yet been demonstrated. The exist ence of such "goitre springs," how-ever, in certain geological fortnations has been established (Bircher, Kocher), but it is not yet quite eleared up in how far other causes may cooperate.
Immigrants into goitre regions fall an easy prey to the affection, especially if they arrive there in infancy. The disease then manifests itself as a strumous tumor, but also as an unex plained glandular atrophy.
The same holds good for young horses, dogs, and mules which in these regions perish in body and intellect with or without the occurrence of thyroid enlargement.
While complete athyreosis as a eonsequence of goitre has never been observed outside of goitre regions, and while in all cases of myxidiocy which have so far corne to autopsy- the gland was totally absent, complication of goitre and athyreosis has only been found in regions where cretinism is endemic, but surprisingly much more frequently complete acquired thyreoatrophy.
The causal connection between the goitre springs and atrophy of a vital organ of a child, born by a healthy mother, herself free from goitre and cretinism, is not yet cleared up. On the other hand, it can easily be understood that, in the pres ence of either an almost intact, a greatly impaired, or totally obliterated glandular function, not only cretins from degenerated families in regions with endemic cretinism may acquire the most extreme form of complete athyreosis—which has become known through Virchow—but also that goitre carriers and goitreless individuals may t here undergo all the gradations of the affection, from the .lightest hypothyreosis to almost complete or the gravest at hyreosis.
Anatomical findings, course, and clinical manifestations are about I he same as in thyreoaplasia.
The behavior of the skin, the relation of physical to psychic eachexia, prognosis, and the effect of organotherapy demand special discussion. Myxcedema is a peculiar swelling of the connective-tissue cells w-hich takes the place of the fat which is otherwise present. It differs only in advanced age from juvenile athyreosis, inasmuch as considerable flabbi ness azid wrinkling of the skin take the placu of the gelatinous, doughy condition. The lanugo hair disappears about the middle of the second, or latest in the third decade of life.
IIowever, little importance need be attached to this divergence, although it has been emphasized by several authors. There is quite an analogical behavior in every undernourished case of complete athyreosis or in its advanced existence.