The Cretinic Degeneration 



NELSON W. JANNEY 



LOS ANGELES 



DEFINITION 



HISTORICAL 



GEOGRAPHICAL AND OROGRAPHICAL DISTRIBUTION 



PREVALENCE, ECONOMIC AND MILITARY IMPORTANCE 



ENDEMIOLOGICAL 



EPIDEMIOLOGICAL 



ETIOLOGY 



PATHOLOGY 



SYMPTOMATOLOGY 



DIAGNOSIS 



TREATMENT 



Definition 



The Cretinic Degeneration may be defined as an endemic disease 

 characterized by goiter, cretinism, deaf-mutism, idiocy and caused by 

 toxins probably of bacterial origin usually introduced by impure water or 

 contaminated soil. Certain epidemiological, etiological, pathological and 

 clinical features of this disease are at such variance as to preclude an 

 absolute identity with hypothyroidism which, however, plays a dominating 

 role in many cases. The relation to hypothyroidism will be developed in 

 the section on etiology. 



Historical 



Goiter was known to the Romans, as various mention of this striking 

 condition is made in the works of Pliny, Juvenal, Vitruvious, Ulpian, 

 who commented upon its endemic occurrence in the Alps. "Quis tumidum 

 gutter miratur in Alpibus" (Pliny 13th Satire). It was regarded as a 

 punishment of the gods. Through the dark ages little mention of the 

 disease is made in the literature. In the 13th century Marco Polo, the 

 celebrated traveler, called attention to the frequency of goiter on the pla- 

 teaus of Central Asia. Several descriptions of the disease appeared in 



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