156 THE CRETINIC DEGENERATION 



most cases slioics hyper plastic manifestations, and always degenerative manifes- 

 tations. The hyperplasia may affect the parenchyma as well as the vessels. 

 The degenerative nature of the alteration is seen in the fact that the hyper- 

 plasia of the parenchyma is for the most part unaccompanied with increase in 

 function. . Therefore either the parenchyma must be less capable of function- 

 ating or the giving off of secretion is hindered by the sclerotic process. For 

 the most part there is found sufficient parenchyma capable of functionating. 

 According to the stronger or weaker participation of the hyperplastic or de- 

 generative processes we distinguish parenchymatous, vascular, or fibrous 

 further, diffuse or circumscribed goiters; when the stagnation of the secretion 

 is greater, we have colloid or cystic goiters. In goiter neighborhoods there 

 also occur hyperplastic congenital goiters. There seems to exist a certain 

 relationship between goiter and myomata of the uterus. At least it has been 

 observed that in strumous women who also suffer with myomata, the struma 

 also decreases in size with the retrogression of the myoma at the menopause 

 (Ullmann). Concerning the further distinctions, the differential diagnosis, 

 and the surgical treatment, I shall refer [the reader] to v. Eiselsberg's mono- 

 graph. Among the nonsurgical methods of treatment, I mention only the 

 iodine treatment. This is the more effective the more the hyperplastic altera- 

 tions and the less the degenerative alterations are present. That in certain 

 neighborhoods iodine therapy often leads to manifestations of hypsrthyrosis 

 has already been mentioned in detail in the chapter on Basedow's disease. 

 The thyroid therapy recommended by v. Bruns is less used nowadays. 

 Not much can be expected from the treatment of ordinary goiter by the 

 X-rays. 



2. Goiter Heart 



The coincidence of goiter and cardiac disturbance is very common. The 

 statistics of Schranz, which are based on an investigation of two hundred and 

 sixty-four goitrous school children, one hundred and seventeen goitrous adults, 

 and seven hundred and twenty autopsy protocols of the Innsbruck Patho- 

 logico-anatomical Institute, show that after subtraction of the valvular de- 

 fects, 23 per cent, of the children and 49 per cent, of the adults suffered from 

 heart trouble. Of the autopsied cases one hundred and eighty-eight showed 

 degenerative alterations of the cardiac muscle, some with hypertrophy. 

 While these figures can only partially stand ground against criticism (Wolfler, 

 Fr. Kraus, Minnich] they are indeed, even when reduced, sufficient to show 

 the common coincidence of goiter and cardiac disturbances. Rose showed, be- 

 fore Schranz, that the stagnation [congestion] in the lesser circulation caused 

 by the large goiter can lead to dilatation and insufficiency of the right heart 

 (so-called Rose's goiter heart). When the embarrassment to respiration on 

 account of the goiter enters more into the foreground we call the condition, 

 following the lead of Kocher, pneumonic goiter heart. Conversely, primary 



