132 THE DISEASES OF THE THYROID GLAND 



V ire June was one of chondrodystrophy (Kauj'mami). This was further 

 confirmed by Weygandt through the microscopical examination of Virchou'~s 

 case. 



Already Argutinsky had mentioned that the development of the bone- 

 nuclei in sporadic cretinism is even more intensely delayed than is the growth 

 in height. If, for example, the size of a twenty-year-old cretin corresponds 

 to that of a six-year-old child, the retardation in the deposition of the nuclei 

 lies even farther behind. In the pure cases with complete lack of thyroid 

 gland the epiphysial joints do not close. In the known case of Bourneville, 

 autopsy, in the thirty-sixth year of age, showed epiphyses that were com- 

 pletely open. The closure of the fontanelles is markedly delayed. In 

 the case mentioned the great fontanelle was still open in the twentieth 

 year. At autopsy in the thirty-sixth year its place was filled by a trans- 

 lucent bony plate. Also Kassowitz mentions cases of infantile myxe- 

 dema with markedly delayed closure of the fontanelles; thus in a thirteen- 

 year-old individual he found the frontal fontanelles still distinctly open. 

 The measurements of the bones, with regard to their thickness and length, 

 correspond to the relations of childhood ; this is then a proportional dwarfism, 

 deviating from the normal proportions of childhood only in the development 

 of the skull. The circumference of the skull does not indeed correspond 

 to the age of the individual, but is distinctly larger than would be repre- 

 sented by the rest of the body structure. In addition there is a remaining 

 behind in the growth of the vomer, that results in a retraction of the root of the 

 nose; this lends to the face the characteristic cretinoid expression, which 

 does not, however, reach the extreme grade as seen in chondrodystrophy. In 

 the four-month-old case, with pure thyroaplasia, of Dieterle, the measure- 

 ments of the bones showed that they about corresponded to those of a new- 

 born child. The disturbance in growth had therefore apparently first made 

 its appearance after birth, and not already in fetal life. The histological 

 examination of the bones in sporadic cretinism showed diminution in the size 

 of the zone of cartilage proliferation, narrowing of the marrow cavity, abun- 

 dant fat-contents of the marrow, and poverty of the marrow spaces in cells. 

 According to Dieterle there also occurs a slowing of apposition and absorption, 

 with normal calcification. This gives rise to a certain degree of sclerosis. 

 With this agrees the observation of Kassowitz and of Dieterle that the bones, 

 when once formed, show an unusual hardness, thus differing from their 

 condition in rachitis. The histological picture of the bones shows a cer- 

 tain senility; the disturbance depends on an equalized delay of the endo- 

 chondral and periosteal ossification. 



It is further characteristic for the disturbance in growth in sporadic 

 cretinism that it reacts to thyroid therapy in a pronounced manner, even 

 when the therapy is first begun after the twentieth year. We shall speak of 

 this in the consideration of the therapy. 



