164 THE CRETINIC DEGENERATION 







persons did not have a goiter. Among the cases with goiter, there was only 

 one in whom was found a hypophysis that could be regarded as probably 

 normal. "In persons with struma of the thyroid, there was always found 

 enlargement of the hypophysis, and indeed either proliferation of the con- 

 nective stroma, also chromophilic strumas, strumas with especially vascular 

 development of the stroma and hyaline degeneration and swelling up of the 

 columns of cells, and finally those with marked colloid formation." v. Cyon 

 found strumous alterations of the hypophysis very frequently in Bernese 

 dogs. The goiter poison therefore works deleteriously on the hypophysis. 



As in sporadic cretinism, the disturbance in bone-growth consists of delay 

 in the epiphysial closures and in retarded appearance of the bone-nuclei. 

 Langhans first described, in the skeletons of five cretins, the remaining behind 

 in the ossification and commented that also the cretinoids show a similar, 

 although less marked, remaining behind. "The bones previously laid out in 

 cartilage grow slowly in their length; the epiphyses remain low, the boundaries 

 of ossification progress very slowly, the nuclei of ossification in the epiphyses 

 occur very late, and the epiphysial discs are retained for long beyond the 

 normal term. Remnants of these discs are still to be found in the forty-fifth 

 year." v. Wyss has confirmed the observations of Langhans by means of the 

 X-ray examination of numerous cretins and cretinoids and incidentally has 

 finally contradicted the previous view that in cretins premature ossification 

 of the epiphysial junctures occurs. This delay in the epiphysial closure 

 makes intelligible, as v. Wyss emphasizes, the former observations of v. 

 Wagner that in endemic cretins, even in late life, the growth in height may go 

 on. To this extent the disturbance in the ossification agrees fully with that 

 in sporadic cretinism, although on the other hand there are differences that 

 are important from the point of view of differential diagnosis. Already 

 v. Wyss pointed out that the retardation in the ossification for the most part 

 lasts only a few years, so that only rarely are the epiphysial junctures found 

 to be open after the twenty-fifth year. 



Dieterle mentions especially the extensive difference from thyroaplasia in 

 this behavior of the epiphysial junctures, which in thyroaplasia, if thyroid 

 therapy be not introduced, often remain open. In youthful age in endemic 

 cretinism, however, the remaining of the ossification behind that of the normal 

 individual is not inappreciable. Dieterle publishes a very instructive table 

 in which he compares the ages of the cretins of v. Wyss as estimated from the 

 radiograms of the hands with the actual ages of the individuals. He finds in 

 eleven cretins between the ages of seven and eighteen years a remaining 

 behind of ossification of from three to seven years. Breus and Kolisko 

 state moreover that in six of the cretin skeletons examined by them never did 

 all the epiphysial junctures remain open until an advanced age, therefore 

 there did not exist in all bones the same degree of disturbance of growth, and 

 that there resulted from this a dispro portioned skeleton; the extremities are 



