172 THE CRETINIC DEGENERATION 



naturally is not evidence, as sporadic cretinism may also occur in some 

 infested neighborhood. The coming from a neighborhood where only goiter 

 but not cretinism is endemic cannot, without other factors, be used against 

 the diagnosis of endemic cretinism, as in such neighborhoods endemic cre- 

 tinism may occur. I refer once more to the small endemic described by 

 Magnus-Levy. Here too, seems to me, belongs the interesting observation 

 of Eller. Eller describes three cases of cretinism in a Vienna family. The 

 patients were goitrous and had never been out of Vienna; three sisters were 

 entirely well; the cretins themselves had strumas. The result of the treat- 

 ment with thyroid, which was not carried out perseveringly, was not 

 satisfactory. 



The finding of a struma, slight or absent myxedematous consistency of 

 the skin, incongruity between mental development and the rest of the symp- 

 toms, relatively slight inhibition of ossification and closure of the fontanelles, 

 unequal remaining behind of the epiphysial closures, slight or absent 

 results of treatment, impossibility of stimulating the metabolism with 

 thyroidin, low tolerance for thyroid-gland substance speak for endemic 

 cretinism. As far as the disturbance in ossification is concerned, it must be 

 considered that this occurs in many vegetative disturbances that have noth- 

 ing to do either with the thyroid gland or with endemic cretinism, v. Wyss 

 already pointed this out; he found in four of seven individuals who, without 

 showing striking symptoms of cretinism had remained behind physically and 

 mentally, pronounced inhibition of growth and of ossification, which were in 

 no wise different from those which are typical for endemic cretinism. We 

 must therefore agree with v. Wyss that in a country in which cretinism is 

 endemic the differentiation between cretins and idiots is extraordinarily 

 difficult. The delay in ossification seems to be found regularly in cretinoids 

 without mental defect. 



Addendum 



Goiter is not at all uncommon in the United States. A close study 

 would perhaps show that goiter is confined in this country to certain districts. 

 Clark and Pierce mention that there are certain districts of endemic goiter in 

 the region of the Great Lakes and certain sections of West Virginia. 



McCarrison was able to produce swelling of the thyroid experimentally 

 in men by administering to them the filtrate of boiled water from a goitrous 

 district. This author cites facts that make it very probable that the noxus of 

 goiter exists in the soil, and may possibly be transmissible from individuals. 



Blood counts from seventy-three cases of goiter made under the direction 

 of McCarrison showed a lessening of the polymorphonuclear leucocytes in 

 98.9 per cent, of the cases and increase of the small mononuclear leucocytes 

 in 92.5 per cent., an increase of the eosinophiles in 88 per cent., and an in- 

 crease of the large mononuclear cells in only 23 per cent, of cases. The 



