1 68 THE CRETINIC DEGENERATION 



On a still larger material is based the report of v. Kutschera as to the treat- 

 ment of endemic cretinism in the Steiermark at the cost of the state. The 

 treatment was given to one thousand eleven cretins; of these a great num- 

 ber was treated for only a short time on account of the insufficient interest 

 of the parents and could not be considered in the judgment of the result. 

 Also there were found numerous individuals who could not be considered as 

 cretins, and who were separated out at a later sifting. Only in 2.4 per cent, 

 of all treated were the tablets not borne well. High-grade idiots and cases 

 of pure mutism were rejected. Of great interest were the cases the growth 

 of which could be followed for a long time. They were four hundred forty 

 in number, of which only 10.2 per cent, showed only a less growth than corre- 

 sponded with the age of life, 4.1 per cent, showed a growth corresponding 

 with this age; 85.7 per cent., however, a growth that exceeded the normal at 

 that age. Especially in the first years of life was the increase in height very 

 significant, but it occurred, too, in individuals at the beginning of the third 

 decade, in whom, under normal conditions, growth would have ceased. As to 

 the total results, which also took into consideration other cretinic symptoms, 

 among six hundred seventy-seven cases there was an appreciable improve- 

 ment in 42.8 per cent., a distinct improvement in 48.6 per cent., and in 8.6 

 per cent, no improvement at all. 



Again, v. Kutschera reports light, previously treated cases, in which 

 complete cure was obtained after a relatively short treatment. 



In rather sharp opposition to these good results are the bad results of 

 Scholz and also of Lombroso. The bad results of Lombroso are concerned with 

 old cretins. Scholz reports concerning a very large number of cases. Scholz 

 treated with thyroid tablets one hundred cretinous children in the infirmary 

 at Knittenfeld. He began with one tablet and gradually increased to three 

 tablets, and in certain cases up to eight tablets, per diem. The results 

 throughout were unfavorable. The body weights quickly sank (in certain 

 cases as much as 36 per cent.). The children became extremely weak, even 

 bed-ridden, the appetite diminished, vomiting and diarrhea occurred, apathy 

 increased; three children died. Increase in height was not observed. Also 

 there were observed other symptoms of hyperthyroidism, such as tachycardia, 

 sweats, etc. v. Wagner believes that these unfavorable results of Scholz 

 depend on too high dosage, v. Wagner and. v. Kutschera gave only a half- 

 tablet to small children and gradually increased to one tablet. Also older 

 individuals were mostly given only one tablet a day. Scholz began with one 

 tablet and increased apparently rather quickly to three tablets, in certain 

 cases even higher. In my cases of sporadic cretinism, however, even much 

 larger doses were necessary over even a longer time before the first manifesta- 

 tions of hyperthyroidism manifested themselves. Scholz later stated that he 

 could not obtain any good results with small doses. Also v. Wagner stated 

 that many severe cases, especially those which he regards as congenital 



