136 THE DISEASES OF THE THYROID GLAND 



velopment of the other ductless glands suffer damage on account of the 

 disturbances appearing in early youth, so that the simultaneous overburden- 

 ing of the alimentary and the nervous factors bring about an appreciable 

 insufficiency. 



The reduction of the metabolic processes expresses itself, here as in 

 myxedema adultorum, in a hypothermia. For the most part the temperatures 

 lie near 36; also in my cases, the level of temperature was low. 



In his case Diederle found during the last week of the life of the patient 

 33.4. Then again an increase of temperature may remain absent when 

 infectious processes occur. However, this is not usually the case. In the 

 case of Bourneville, already mentioned many times, the temperature during 

 a case of erysipelas rose to 40 Celsius. 



The statements as to the behavior of the hypophysis in sporadic cretinism 

 do not agree. Extirpation of the thyroid gland in young rabbits leads to 

 enlargement of the hypophysis (Rogowitsch, Gley, and others). Microscopical 

 alterations of an apparently degenerative nature have been many times 

 described. Again, in many cases of sporadic cretinism the hypophysis or 

 the sella turcica is enlarged. In my case, however, the X-ray examination of 

 the skull showed no enlargement of the sella. Schilder likewise found in his 

 three cases of thyroaplasia no enlargement of the sella; but on microscopical 

 examination he found peculiar cells that approached near to the so-called 

 "pregnancy cells" of the hypophysis. 



In sporadic cretinism the thymus gland often seems hypoplastic ; Pineles 

 found thyroaplasia and thymus aplasia combined. Bernheim-Karrer and 

 Rucacz-Gruchet found only slight rests of the thymus. Other observers 

 found the thymus normally developed. 



The marked inhibition in the development of the osseous and the blood 

 systems and the ductless glandular system would lead us to expect that there 

 would also be something wanting in the development of the central nervous 

 system. This in the high-grade cases expresses itself not only in the absence 

 or remaining backward of the mental and psychical development, but even 

 in the inability to carry out the movements that subserve finer coordination. 

 As Kassowitz observes, the children learn late to balance their heads, to sit, 

 and to walk. 



Such cases, as for instance the case of N. described (Observation XV), 

 have almost nothing human left about them. They give utterance to only 

 some inarticulate sounds and almost every sign of mentality is absent. 

 They do not go to the toilet to void urine or feces. N. always devoured his 

 feces whenever he could get access to them. In lighter cases the disturbance 

 of mental development is somewhat shorter. Usually the sense of smell is 

 well developed. 



The statements as to disturbances of hearing in sporadic cretinism are very 

 diverse. The assumptions as to the cause of these diverge greatly. It is 



