There is usually an enlargement of the liver. Respiration is unusually slow in the severe athyreoses. The genital organs show marked changes. The labia are small, the external not covering the internal ones. The uterus and ovaries are usually small, and the mammary (glands are atrophic or hypoplastic. The penis is apt to be small, the testicles undescended, and small. Genital hair and that in the arm pits is absent or scanty. In boys the puberal changes in the voice are lacking.
Nervous system defects are present with the others and apparently conditioned by the endo crinous gland insufficiencies. These show at vital levels in the deficiencies of the sensory and motor nerves, and at psychical levels in va rious grades of stupidity, mental weakness (moron), imbecility, or even idiocy— these words being used according to the arbitrary scaling of the Binet-Simon tests.
Thus smell is at times defective. The eye sight is poor, hearing is frequently disturbed and with it speech, so that many patients are deaf and dumb. The vestibular function is fre quently involved, so that these patients balance badly, often showing unsteady gait, wobbling of the head and nystagmus. Some sporadic cretins may show little disease of the nervous system.
Cretinoid Mention has been made of the widespread character of this type of degeneration related to defective or ab sent thyroid secretions. The statistical study of the conditions, particularly in Switzerland. in France and in Italy (Bircher), has shown that goitre, goitrous heart, endemic cretinism, en demic deaf and dumbness and endemic feeble mindedness are closely allied. The cretins are almost all goitrous, or nearly always have goi trous parents. Exophthalmic goitre (hyperfunc tion) is rare with goitre, but very frequent with goitrous heart conditions. (See GOITRE). The causes of the hypothyroidism are not definitely settled, but there seems to be a constant relation between it and certain factors in certain waters, so that goitrous springs are known. Just what the noxious element may be is still conjectural. but it apparently is related to mineral constitu ents found in certain geological formations, no tably in the Trias and Tertiary. The disease is absent in regions fed from waters of crystalline formation. Through Bircher's suggestion of
supplying a goitrous region in Rupperwill from Jura water supplies, in an adjacent valley, the disease disappeared. Similar results followed in the town of Asp. Animals may be made goi trous from drinking water from certain springs. They also develop goitrous hearts and are de layed in their development. The thyroid shows degenerative changes. The agent passes through a Berkefeld filter, but is modified and made non-active by being heated to 70° C. It does not dialyze and is not thought to be an organ ized plant or animal substance, but is of a col loidal nature. An hypothesis which had the au thority of Bircher behind it was that the dis ease was of an infectious nature.
Endemic Here there is a richer and much more variable picture than obtains 'for sporadic cretinism. Whereas a typical habitus is described, there are many anomalies and variations. The head is usually broad (but may be small and flat, instead of large and broad), at times very large. The nose is usu ally wide spreading and flat, the eyes wide apart. The neck is short and thick, the features swol len, the facial expression, especially of the prognathism, is one of moroseness or stolidity. The bones are shortened, various anomalies as scoliosis, ankyloses, etc., being present. Great variation in dwarfism is observed. Certain cre tins are under three feet six inches, but full cretins have been observed of seven feet in height. As a rule they die young, but Kocher reports cretins 70 and even 100 years of age.
The general co-ordination of these patients is poor. They are usually short, clumsy, un elastic with badly developed masculature. The skin is loose, lax, anemic, marked with folds and wrinkles, giving a peculiar appearance of old age. The lips are swollen, the tongue is enlarged and not infrequently protruding. The breasts are flat or badly developed, the abdomen flat or pendulous. Short stumpy fingers and toes give an ugly appearance to the extremities and contribute to clumsiness. The entire activ ity is apt to be heavy and awkward, although a, few athletes and acrobats may be found among cretins.