THE CRETINIC DEGENERATION 



The enormous social significance of the cretinic degeneration in the coun- 

 tries affected by it may be seen by a glimpse at the following figures, which 

 I take for the most part from the works of Ewald and E. Bircher. In Switzer- 

 land 7.2 per cent, of the applicants for military service must be rejected on 

 account of goiter, and 2 per cent, must later be discharged. In Cisleithania 

 there occurred for every 100,000 inhabitants 71 cretins; in many strongly 

 infested districts, for example, in Murrau, in the Steiermark, there are more 

 than 1000 cretins per 100,000 inhabitants. In France, in 1873, there were 

 about i per cent, goitrous among the inhabitants and 0.3 per cent, cretins 

 and idiots; in Piedmont in 1883 about 0.15 per cent, of cretins; inLombardy 

 0.2 per cent., etc. The etiology of this affection is not as yet explained. 

 The study of the geographical distribution shows that goiter, goiter heart, 

 endemic cretinism, and endemic mutism belong together. Typical Basedow's 

 disease is rare in goitrous districts. Manifestations of hyperthyrosis are 

 commonly found there combined with those of goiter heart. The parallelism 

 in the distribution of endemic mutism with that of endemic cretinism is 

 convincingly shown by the investigations of Bircher for Switzerland, and the 

 statistics of v. Wagner for Austria. For lower France, there are the observa- 

 tions of Lobenhojfer. The group relationship of goiter and endemic cretinism 

 is seen not only in the fact that the cretins are almost always goiter carriers, 

 but also through the almost unexceptional occurrence of goiters in the ancestry 

 of the cretins. This and other established facts point to a common etiological 

 factor in the different forms of the cretinic degeneration. As to this all ob- 

 servers agree. On the contrary, there is as yet no agreement as to the ques- 

 tion whether the manifold manifestations of the cretinic degeneration are 

 called into existence only by the mediation of the strumous degeneration of 

 the thyroid gland, or whether a part of these are directly produced by the 

 strumous noxus and thus are coordinate with the struma. 



The cretinic degeneration is found in Europe especially in the central 

 Alps; large goitrous districts exist in addition in the Carpathians, the German 

 middle mountains, and the Pyrenees. In the other parts of the earth, also, 

 the goiter districts lie in mountainous districts. The goiter districts change; 

 localities that were formerly infested become goiter-free, and conversely. 

 Sometimes there occurs an epidemiform breaking-out. When the affection 

 retrogresses in one district, first the most severe forms of the cretinic degenera- 

 tion disappear for the most part, while the goiter alone remains for some time 



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