ENDEMIC CRETINISM 



161 



as Bournei'ille taught of idiots' brains. The brain substance of cretins, accord- 

 ing to Scholz and Zingerle, is often strikingly compact, the amount of gray 

 matter [relatively] exceeding in mass the white. 1 The disturbances of de- 

 velopment may affect different parts in very different ways. The inhibition 

 of the development of the sense organs is certainly to be ascribed, in part, to 

 the faulty development of the central organs. 



The nervous status commonly shows increase of the reflexes, according to 

 Scholz in 52 per cent.; the field of vision was found by Ottolenghi to be re- 

 stricted, especially outward and upward. Hitschmann found the eye 

 grounds normal in nearly all his cases; only in certain cases were crescents 

 directed downward found, relationship of which with the cretinic degenera- 

 tion was entirely obscure. The testing of sensibility, of the sense of taste and 

 smell, naturally presents great difficulties. 



FIG. 21. 



FIG. 22. 



FIGS. 21 AND 22. Cretins with myxedematous facial expression. 



The disturbances of hearing are of very diverse degrees. In many cases, 

 the power of hearing is fully intact. In others, there exists a slight or severe 

 grade of hardness-of-hearing or mutism. Frightfully large is the number of 

 mutes who are completely deaf. 



Endemic Mutism. In all countries in which cretinism is endemic there 

 is found a large number of deaf-mutes. According to the older statements 

 of St. Lager, Switzerland possesses five thousand cretins and four thousand deaf- 

 mutes. To the latter, of course, belong some cases of sporadic mutism, that is, 

 those which depend on a meningitis in earliest youth, on otitides or formation 



1 1 have here rectified the author's error by reference fo Scholz and Zingerle' s article. The 

 German text here transposes "white" and "gray." Editor. 

 ii 



