ENDEMIC CRETINISM 163 



was very slight, and that of urea, the xanthin bases, ammonia, and sulphuric 

 acid showed corresponding proportions. There was further noted a tendency 

 to retention of phosphorus and nitrogen. The metabolism therefore shows 

 a relation analogous to that in myxedema. 1 Very interesting are the results 

 of feeding with thyroid gland. Diuresis increases. The nitrogen elimination 

 was not, however, essentially influenced, while the body weight diminished. 

 Therefore chiefly nitrogen-free substances must be consumed. 



As the cretins investigated showed no distinct myxedematous swellings, 

 it was not to have been expected that the initial increase of the protein 

 combustion observed in myxedema would be present. The experiments 

 all show that the depressed protein exchange in endemic cretinism cannot be 

 stimulated so easily as in myxedema. I cannot see in this an analogy to 

 Basedow's disease, as Scholz does, as the absence of a further increase of 

 nitrogen elimination through thyroid substance in Basedow's disease may 

 have its ground in the circumstance that the excess of thyroid-gland secretion 

 does not come distinctly into action, if in higher grades of hyperthyrosis the 

 energy of the protein decomposition has reached a great intensity. Scholz 

 further observed in his experiments that under the influence of administra- 

 tion of thyroid gland, the calcium in the urine decreases markedly and in- 

 creases in the feces, as we have also observed in normal individuals. 2 



For the most part there is found in cretins a fairly evident hypoplasia of 

 the genitalia. In women the labia and the uterus are mostly small, but it 

 may happen that the external genitalia are relatively well developed; the 

 ovaries are small and often show small cystic degeneration; the menses are 

 absent or are scanty and irregular; the mammae are poorly developed and with- 

 out glandular tissue. In men the penis is often very small, the testicles are 

 not well descended, and on microscopical examination show spermatozoa 

 very sparingly. The scrotum is lax. In both sexes the secondary sexual 

 characters are for the most part very defectively developed; the sexual in- 

 stinct is entirely absent or is very weak only; in many a light case, however, 

 procreative power and conception are observed. E. Bircher reports con- 

 cerning a cretin of the most severe grade who conceived; the fetuses, how- 

 ever, are not capable of living, even when, as in a case of Eppinger, they show 

 no sign of cretinic degeneration. The genitalia can, however, like ossifica- 

 tion, still show a late development. 



Worthy of observation are Schonemann's investigations, which show that 

 in neighborhoods where goiter is endemic strumous alterations are found 

 very commonly in the glandular part of the hypophysis. Among one hundred 

 twelve cases, the hypophysis was normal in only twenty-seven. These 



1 "Not however to experimental athyrosis proper." This statement of Scholz is unintelligible 

 to me, as according to my knowledge, an essential difference between the metabolism of myxe- 

 dema and that of cachexia thyreopriva does not exist. 



2 See the chapter on hyperthyroidism. 



