ENDEMIC CRETINISM 165 



slender but shortened near the trunk, and there exists in this respect a differ- 

 ence between the cretinic dwarfism and the true dwarf described by A . Pal- 

 tauf, in which all epiphysial closures remain behind, in like manner, as in a 

 former child stage of development. In those cases of endemic cretinism in 

 which the epiphysial closures are already ossified, thyroid therapy can natu- 

 rally no longer lead to growth in height. 



E. Bircher has recently studied the disturbances in growth in endemic 

 cretinism in a large number of cases (fifty-six) and has come to the same 

 results as Breus and Kolisko. The inhibition of the ossification affects 

 only the age of development. After thirty years of life the epiphyses and 

 synchondrosis were found open only exceptionally. Also Bircher found 

 throughout that the inhibition in the individual bones is quite dissimilar 

 and leads to a disproportioned skeleton. Not rarely E. Bircher found a 

 coxa vara or a humerus varus. 



Of quite a manifold nature are the findings as to the teeth of cretins. 

 Kranz examined thirty cretins from the Knittelfeld Institute in Steiermark 

 as to jaw and tooth formation, and found numerous anomalies of the jaws, 

 retarded teething, and factors giving rise to anomalies of the position of 

 the teeth. Further he commonly found alterations of the structure, de- 

 fects of the enamel, hypoplasias and erosions and very frequently caries. 

 That these anomalies were not produced by the experimental extirpation of 

 the thyroid gland in animals is made intelligible by the conception that 

 athyrosis or hypothyrosis and endemic cretins are different conditions. 



Very frequently statements are made that endemic cretins are anemic; 

 with this agrees the fact that Langhans found in a grown cretin much fat 

 marrow and little functioning marrow in the long bones. I was unable to 

 find statements as to the leucocytic formula in endemic cretinism. Mc- 

 Carisson, however, reports on the basis of over one hundred blood examina- 

 tions in endemic goiter a regular increase of lymphocytes and in most cases 

 hypereosinophilia. 



The statements as to the thyroid gland in endemic cretins vary greatly. 

 v. Wagner found not a single normal thyroid in inspection of the neck of two 

 hundred cretins. Very commonly the thyroid is not palpable, but very little 

 value can be ascribed to this statement. In the most cases are found goitrous 

 degeneration with atrophy. DeCoulon found in the thyroid gland of five 

 cretins, who died at the age of twenty-six to thirty years, very little normal 

 thyroid-gland parenchyma. One of these cases was fairly well developed 

 mentally. Hanau examined three thyroid glands that all were small and 

 showed a marked disappearance of the parenchyma. Also Bayon and Get- 

 zowa found high-grade degenerative processes, marked diminution of the 

 functionating parenchyma, and enormous development of hyaline-degener- 

 ated connective tissue. Getzowa found, however, similar alterations also in 

 the thyroids of idiots and microcephalies who did not show dwarfism. On the 



