ENDEMIC CRETINISM 159 



swelling and myxedematous alteration of the mucous membrane. Scholz 

 found the skin only atrophic. In 60 per cent, of the cases investigated by 

 E. Bircher the myxedematous swelling of the skin was absent. There are 

 also cases that sweat profusely. The hairs are for the most part short and 

 bristly, the nails torn, the teeth defective, the hair in the axilla:! and on the 

 pubes may be absent or only sparsely developed. Umbilical hernia in chil- 

 dren as well as obstipation and distention of the abdomen is just as frequent 

 as in sporadic cretinism. Often conjunctivitides are found, and as a result 



FIG. 18. Group of endemic cretins from Aarau. 



of these, eczema of the palpebral borders. According to Hitschmann, the 

 conjunctivitides probably develop through disturbance in the leading off of 

 the tears on account of the saddle nose. There mostly occurs a fairly high 

 degree of anemia. The disturbances of intelligence of the cretins may vary 

 from the slight grades of feeble-mindedness up through all the grades to the 

 failure of all mental expression the so-called plant man. In such cases 

 all development of speech is also absent. In most cases, however, some psy- 

 chical development is still present. The perception, however, is somewhat 



