392 NELSON W. JANKEY 



even more than the height and size of the body (Argutinsky). Open 

 epiphy seal 'junctions may persist quite late in life in untreated sporadic 

 cretins. Periosteal as well as endochondral bone formation may be greatly 

 reduced and delayed. The long bone shafts may be the seat of osteoporotic 

 and sclerotic changes, the marrow cavity is usually small, the periosteum 

 thin. 



The skull is likewise affected. It is larger proportionally than the rest 

 of the skeleton though not reaching normal size. The cranial bones are 

 thin, poorly ossified and osteoporotic mottling is sometimes evident ront- 

 genologic^lly. Occasionally thickening and sclerosis may be present. 

 Besultingly incomplete closure of the fontanelles is very common. This 

 may persist to adult age. In Bourneville's case the great fontanelle re- 

 mained open till the twentieth year and never completely ossified. In the 

 writer's series, a twenty-three year old cretin exhibited a saucer-like tender 

 depression in the skull, the site of the great fontanelle, which was, how- 

 ever, closed with an osseous plate. The facial region and basis cranii re- 

 main especially underdeveloped, giving rise to the protuberant forehead 

 and small features of the cretin. 



The microscopic appearance of the cretin's long bones is regarded by 

 Dieterle, F. Siegert, et al., as characteristic. The cartilage proliferation 

 zone of the epiphyses is decreased in thickness. The ground substance 

 is augmented in amount. The cartilage cells appear in fewer numbers. 

 The normally regular epiphyseal line of ossification is broken by ingrowths 

 of the marrow substance and is demarcated from the diaphyses by densely 

 laminated cross partitions of bone. This peculiar osseous- formation is 

 laid down when growth ceases as a final expression of the proliferating 

 activities of the marrow cells and is regarded as especially characteristic 

 of cretinism. The osteosclerotic and osteoporotic processes show no un- 

 usual features. The marrow undergoes degenerative changes. 



The muscles are infiltrated with mucoid material and may show cloudy 

 swell ing, fatty degeneration. The effete substances arising in their 

 metabolism tend to accumulate in the body. The pathologic changes prob- 

 ably come on very early as muscular weakness is one of the earliest signs 

 of hypothyroidism. 



The yenito-urinary system exhibits the usual picture of imderdevelop- 

 ment and degenerative changes, generally characteristic of hypothyroidism. 

 The kidneys are often small in size in young subjects. Histologic studies 

 have been rarely reported, but from the frequency with which albuminuria, 

 cylinduria and even nephritis are known to occur their probable degener- 

 ative nature may be readily surmised. 



The genitalia are hypoplastic and functionally deficient. 



Lesions in Other Endocrin Glands. Other ductless glands may show 

 degenerative changes precisely as do all other tissues and organs of the 

 body ior it is likely that the nutritive processes of the endocrin organs 



