382 NELSON W. JANNEY 



and these difficultly distinguishable clinically from other cretins. These 

 cases are therefore described by us under the general clinical title Hypo- 

 thyroidism. > 



The term Cretin, signifying a small hypothyroid individual, is so 

 firmly established in medical minds of many countries that an attempt 

 to relegate this appellation to disusage would be most inadvisable. The 

 word may be derived from the Latin creta, "chalk," or French cretien, 

 "innocent," but more likely originated from the Rhaeto-Romanic crei, 

 cretin, "dwarf," "little" (Royan). Some slight confusion has, however, 

 arisen from the term "endemic cretinism" which is not general enough to 

 include, as it should, the various manifestations of this degenerative dis- 

 ease. On the whole, however, it seems advisable to retain the term cretin 

 or cretinism as clinically descriptive of the typical dwarfed hypothyroid 

 case but without further significance. 



The term "Myxedema" (Ord, 1878) is usually applied as synonymous 

 with severe hypothyroidism in adults and refers especially to the peculiar 

 thickened cutaneous areas. It is therefore only descriptive of the general 

 symptomatology through force of usage. It seems, however, worth while 

 to continue this term as comprehending the classical manifestations of 

 hypothyroidism in adults. There seems little excuse, however, for such 

 terms as infantile myxedema; juvenile myxedema, etc. Strictly speaking, 

 myxedema is but a single symptom of hypothyroidism. 



Other appellations for hypothyroidism are the French "cretinisme," 

 "cachexie pacliydermique" German "Jcretinismus" Italian and Spanish 

 fe cTetinismo " Latin ft cacJiexia strumipriva and tliyreoprivd." 



In the present treatise the medical condition resulting from loss of 

 thyroid function is described under the single heading "Hypothyroidism" 

 as no really significant distinction can be logically drawn between so-called 

 cretinism in children and adult myxedema. Certainly age is no criterion 

 as adult and even senile cretins are known. This conception will be devel- 

 oped in the clinical section where it will be emphasized how goiter, cre- 

 tinism, myxedema and, indeed, all pathological changes due to loss of thy- 

 roid function may merge into each other. 



Geographical Distribution 



Hypothyroidism may occur among all races and in all countries, 

 though negroes and Chinese are rarely affected. Cases have been more 

 frequently encountered in cold climates. This may possibly be due to 

 the increased caloric requirement in cold weather which is largely con- 

 trolled by the thyroid. The especial prevalence of the disease in England, 

 France and Germany and other Northern European countries, as reported 

 by many writers, may be partly accounted for by the concentration of 



