SPORADIC CRETINISM 121 



became coarse and showed decrease in solidity. After a longer time the 

 bodily weight of the control animal often attained to three times that of the 

 thyroprivic animal. In addition were found distention of the abdomen, 

 anemia, atheromatous degenerations of the great vessels, atrophy of the geni- 

 talia, reduction in temperature, curving of the bones, trophic alterations of 

 the hair, dryness of the skin, senile marasmus, and pronounced idiocy, in 

 short the picture of idiotic dwarfism. The changes in human beings when the 

 function of the thyroid becomes deficient in early life are entirely analogous. 

 The lack of thyroid may be either congenital (thyroaplasia or thyrohypoplasia) 

 or the same changes that cause myxedema of adults may affect the thyroid in 

 early life (spontaneous infantile myxedema), or, as already mentioned, a 

 surgical procedure may lead to thyroid insufficiency (postoperative infantile 

 myxedema) . 



Pineles, who was the first to separate thyroaplasia from the entire group 

 as an etiologically unitary form, wished to avoid the expression sporadic 

 :retinism and to distinguish only between thyroaplasia and infantile 

 myxedema. It seems to me, however, that this sharp distinction is not 

 practicable. It is true that infantile myxedema makes its first appearance 

 in the fifth or sixth year of life, while in thyroaplasia the exhibition of develop- 

 ment begins gradually to manifest itself already in the first year of life. 

 Infantile myxedema may, however, also develop at the earliest age. If 

 the damage to the thyroid in these cases is a material damage, the intensity 

 )f the inhibition of development is the same as in thyroaplasia, and as the 

 inding on palpation when negative is not decisive, so a certain differentiation 

 >etween these two conditions is hardly attainable in vivo, especially if the 

 idividuals first undergo an exact physical examination at a later stage of life, 

 therefore wish to retain the name sporadic cretinism for the entire group. 

 Siegert embraces all the cases of lack or deficiency of the thyroid gland in 

 :hildren, together with endemic cretinism, under the name myxidiotie 

 [myxidiocy]. As I do not regard endemic and sporadic cretinism as entirely 

 )f similar nature, I cannot subscribe to this designation. 



In his excellent work on thyroaplasia, Pineles collects from the older litera- 

 ture twelve cases in which the thyroid was absent microscopically at autopsy. 

 Almost all the individuals affected died at an early age; in the fewer older 

 idividuals who had attained the age of puberty it seems that the demonstra- 

 tion of a complete aplasia of the thyroid was not certain, or the cases had been 

 reated with thyroid tablets (MacCallum and Fabyan). Also Thomas Erwin 

 remarks this. In the case of Fletcher-Beach, that concerned a fifteen-year-old 

 jirl, a certain intelligence had developed. She had learned to write and use 

 igures, and had menstruated two or three times. The autopsy indeed 

 showed absence of the thyroid gland, but as such a development is hardly 

 )ossible with a complete thyroaplasia the publication of this case occurs 

 )efore the era of thyroid-gland therapy it is possible that here accessory 



