On the other hand, there is a noteworthy difference in behavior between physical and psychic cachexia in endemic genuine cretinism_ They do not run parallel by any means, and the most pronounced dwarfish structure occurs with only slightly impaired, eretinoid intelligence, and on the other hand, the most pronounced idiocy may occur with but slight physical c ac Weyganclt explains mental idiocy by peculiar brain findings which he has also observed in thyroidectomized animals. He described the same from a Nissl operation as follows: "Unusual length of the apical process of the corticoganglionic cells, being about five times as long as the cell itself; pigmented nucleus, decomposition and atrophy of the cell body, and granular decomposition of the ganglionic cells. The axis cylinders were not visible in places, the dentrites only slightly." Finally, I may add a few words concerning the contradictory state ments in regard to the efficacy of organotherapy.
It is intelligible that this form of medication will be ineffective in members of a family deg,enerated for generations and living in a region of endemic cretinism, especially when the affection sets in after many years of illness; also that the result may be variable in young individuals and in congenital non-endemic thyreoplasia. Better illustrations, how ever, are furnished by the increasing and partly brilliant successes in cretins who are stigmatized as genuinely endemic by the repeated occur rence of goitre and cretinism in several brothers and sisters in a family living in regions of endemic cretinism. (Magnus-Levy, Slazek, Wey. gandt, and others.) All the three forms of complete athyreosis: congenital and acquired thyreoaplasia, and cretinism, demand the same treatment as athyreosis.
Treatment consists simply in replacing the absent thyroid secretion by the administration of thyroid gland or its extracts. Christiani inaugu rated the transplantation of live thyroid substanee, based upon animal experiments, but as long as the certainty of permanent function of the transplanted organ is not yet established, the adoption of his suggestion must remain in abeyance.
Organotherapy produces without exception rapid and favorable results after a few (lays' administration in all cases where there is complete athyreosis.
Figs. 124, 125, 126, and 127 will illus trate this fact better than any description.
The soft parts, mucous membranes, hair and nails become normal, the distended abdomen and umbilical hernia disappear, normal respiration is established, and solid nutrition may be partaken of. Natural digestion is attained at once. There is rapid, exaggerated osseous growth, rapid dentition and normal perspiration. Tem perature, pulse, and metabolism return to normal and the psychic development keeps step with the physical at a remarkably rapid rate. Apathy disappears, spontane
ous, reflected actions are carried out, and in the place of a torpid manner there is gay and sprightly conduct. A few weeks have sufficed to change a repugnant, animal-like cretin into a pretty human being.
Specific organotherapy, especially at the beginning of its administra tion, crowds weeks of normal development of body and mind into as ninny days, years into as many months. This is strikingly proved by the radiogram of the hand, showing that in a very short time the epiphy seal nuclei were formed which normally- require one, two or more years for development.
I have observed an increase of 15 to 1S cm. in height (luring the first year of treatment in a five-year-old patient, 8 to 10 cm. being the rule during the first five to six months. Dentition often occurs as early as in the second or third week of treatment and may lead to a complete set of teeth within a few months. Coordination rapidly asserts itself ; children who could previously not stand unaided, can walk unassisted ins. few days.
With equal rapidity comes intelligent action, understanding of speech, cleanliness and systematic feeding. Enunciation of coherent words, however, causes effort and demands time. Jaffe and Saenger have reported a case of congenital athyreosis, where organotherapy VCRS started at the age of five, leading to coract speech and normal intelli gence in three months., but this is an exceptional case. Better and earlier results, however, will be produeed when the affection has been aequired in the second year of life, or later. Generally speaking, however, these children ean only be placed in schools for the mentally deficient, and a certain dwarfish growth in body and n-iind will never be quite overcome.
The final result in acquired athy reosis will depend even more than in congenital absence of the thy roid on early medical aid and the degree of development already present.
Although the originally high flowing expectations in regard to the specific treatment of absent thyroid have in time become less sanguine, the repeated radiographic pictures provide the physician with a safe basis by which to judge the degree of progress and possibility of development. If, after a few months' treatment, the phalangeal earpal nuclei make an appearance in correct succession, if they as w-ell as the phalanges, the metacar pals, the epiphyses of the radius and ulna, show satisfactory growth, a large measure of success is as sured, even in an intellectual direc tion. And as long aS the cartilaginous epiphyses are not ossified, further growth is possible while organotherapy is continued.