1 66 THE CRETINIC DEGENERATION 



other hand, Bircher, Sr., found abundant normal thyroid-gland tissue in the 

 thyroid gland of one of the cretins that he operated on. Recently E. Bircher 

 reports on the examination of over sixty cretins' thyroids, obtained at 

 autopsy or at operation. Degenerative processes were present in all, but 

 were of extremely varying intensity, which often did not run parallel with the 

 intensity of the affection. In all thyroids moreover were found large por- 

 tions of normal thyroid-gland tissue. E. Bircher found similar conditions in a 

 series of endemic deaf-mutes. Accordingly there were found in almost all cases 

 sclerotic and atrophic processes, but in addition always some functionating 

 parenchyma. Hence there was no struma whose histological picture was 

 characteristic for cretinism, v. Werdt arrives at the same conclusion on 

 the ground of the examination of five strumas that histologically showed 

 entirely the picture of a cretin's thyroid, without there being any sign of 

 cretinism whatsoever in the actual cases. 



No essential alterations have as yet been found in the parathyroid glands 

 in cretinism (Scholz, Getzowa, E. Bircher}. 



Treatment. Before I consider the question as to the role that thyroid 

 insufficiency plays in endemic cretinism, I should like to speak about the 

 results of thyroid therapy. There are in the literature very contradictory 

 statements as to this. v. Wagner saw very good results. They consisted in 

 the disappearance of the myxedematous swellings, in the rapid development 

 of the genitalia, which had remained behind, in the diminution in size of the 

 enlarged tongue, and even in the disappearance of an umbilical hernia, in 

 falling out of the bristly hair and development of new hair of normal texture, 

 in acceleration of dentition, before all, however, in the diminution in size of 

 the fontanelles that had remained open, in the acceleration of ossification and 

 in increase in height. The least satisfactory were its results on the psyche; 

 it is true that there was usually a decrease in the apathy and in the lack of 

 movements, yet the increase in the intellectual capability was usually very 

 slight. 



v. Wagner lays especial stress on the earliest possible beginning of the 

 therapy. He also saw good results in individual cases from administration of 

 small doses of iodine (through stimulation of the activity of the thyroid 

 gland?). Still better results were obtained by Magnus-Levy in fourteen 

 individuals from three neighboring villages from upper Munstertal in the 

 Vosges. These individuals came from seven families. The cretinism had 

 appeared in this neighborhood only a short time previously; goiters were 

 usually present in the relatives, and also the parents showed symptoms of 

 slight goitrous degeneration. In the individuals themselves the thyroid was 

 in many cases not palpable, only in a few goitrously degenerated. The 

 majority showed fairly well pronounced myxedematous symptoms. In the 

 severest cases were present lordosis and pendulous abdomen, in all constipa- 

 tion and faulty development of the genitalia. One case was highly deaf. 



