ENDEMIC CRETINISM 167 



It is further worthy of note that a case that had developed fairly normally up 

 to the tenth year first showed signs of cretinic degeneration at the close of an 

 attack of pertussis, and finally in the sixteenth year showed a rapid deteriora- 

 tion with distinct signs of myxedema; in none of the cases did there exist com- 

 plete dementia. In all these cases there was a distinct improvement already, 

 four to six weeks after the institution of thyroid therapy. After one and one- 

 half years only one case showed an increase in height as low as 4 cm. all the 

 rest 11-17 cm - The myxedematous manifestations disappeared, and the 

 intellectual ability improved considerably. Also v. Eysselt saw good results 

 in forty-six cretins in the Littauer Amtbezirke [official district] in Mahren. 

 In two the development of the genitalia was especially influenced. Also 

 Safer saw favorable influencing of the growth, and in addition also a severe 

 loss in weight. In two later communications v. Wagner reports about nu- 

 merous cases that were treated with very good results. Also in these com- 

 munications v. Wagner points out that the results were more favorable the 

 sooner the treatment was begun. In certain light cases a cure may be ob- 

 tained which persists even after withdrawal of the therapy. But even when 

 the therapy is begun in late life good results can be obtained. In the 

 severer grades of cretinism the result was indeed not so satisfactory. 



Also the hardness-of-hearing may become essentially improved. Many 

 cases of hardness-of-hearing, however, do not improve. 



According to v. Wagner, cretinism for the most part is not congenital, but 

 in the great majority of cases signs of cretinism first make their appearance in 

 the first years of life. For an early diagnosis are important, first of all, the 

 absence of disturbances of gait and speech, then the pale color of the face, the 

 swellings of the skin, the apathy, the retardation of the closure of the fontan- 

 elles and the dentition, the gradual retraction of the root of the nose and the 

 remaining behind in growth. In such cases of acquired cretinism a much 

 better result of thyroid treatment may be expected. 



As an especially pretty example of the increase in height, I shall quote the 

 following case of v. Wagner: A fifteen-year-old boy is 105 cm. tall at the 

 beginning of the treatment; after a four years' treatment he has grown about 

 43 cm. that is about 29 cm. more than corresponds to the average growth at 

 this period of life. The typical saddle-nose and the apathy have dis- 

 appeared, he articulates fairly well, the hearing has improved, etc. On the 

 contrary, cases in which the cretinism appears so early that we must assume a 

 congenital cretinism are for the most part fairly refractory. In these cases an 

 influencing of the disturbances of speech and intelligence is completely absent. 

 But also in such cases a result seems possible when the treatment is instituted 

 a short time after birth. Those cases of v. Wagner which after an initial nor- 

 mal development first remained behind in body and mental development after 

 an infectious disease could indeed in part also be classified with sporadic 

 cretinism. 



