442 tfELSOtf W. JANtfEY 



the 14th and 15th centuries of which that of Paracelsus was epoch making. 

 This write* described goiter and endemic cretinism in the Salzburg region 

 where it still remains endemic, and emphasized as well the intimate rela- 

 tionship between these expressions of endemic cretinism. In the literature 

 of the 16th and 17th centuries a number of superficial observations ap- 

 peared on the occurrence of the disease in various endemic areas in Europe. 

 Careful studies of the disease were furnished by a coterie of authors at 

 the end of the 18th and beginning of the 19th centuries, among them 

 Saussure, Malacarne of Turin, Fodere, Ackermann and the Wenzels. 

 Keeping pace with the rapid development of medical knowledge during the 

 19th century, there has been contributed during this time a voluminous 

 literature on the endemiology, etiology and pathology of Cretinic Degen- 

 eration, the mere enumeration of which would exceed the size of the present 

 article/ The contributions of the following are of especial significance: 

 Bircher, Coindet, F. Meckel, Huscke, Maffei, His, Dohrn, Eulenberg, 

 Lebert, Koelliker, Klebs, Kocher, Liicke, W. Mueller, Oswald, St. Lager, 

 Woelffler. 



The geographical and endemiological data of endemic cretinism have 

 been classically presented by A. Hirsch, whose monograph should be 

 consulted. Of late monographs and articles, those of Ewald, V. Wag- 

 ner, Lobenhoffer, Dieterle, Scholz, Wagner v. Jauregg, Siegert, Thomas, 

 Wieland, Crotti, McCarrison, Dock, Falta, Marine and Lenhart, also 

 Gaylord, are of especial importance. (See Bibliography.) 



Geographical and Orographical Distribution 



The geographical distribution of endemic cretinism has of itself been 

 the subject of a large literature among which the monographs of Hirsch, 

 Bircher (a) and McCarrison (d) (the two latter with maps) are of especial 

 value. The chief foci of endemic cretinism in Europe are the Central Alps 

 from which endemic areas radiate in various directions. Thus the disease 

 is common in Switzerland, the Tyrol, Carinthia, Steiermark, the Savoy, 

 Basses-Alpes, Alpes-Maritimes, Haute Garonne. There are also a num- 

 ber of secondary centers situated in mountainous districts or deep valleys, 

 such as the Carpathians, the Vosges, Cevennes, the German mountains, the 

 Pyrenees, the Knglish Pennine, Cotswold and Menclip ranges, though the 

 disease is rare in the Scottish Highlands and the Norwegian mountains. 

 The tendency of the disease to appear in mountainous districts is not 

 limited to Europe for marked endemic areas are found in the Caucasus, 

 the TTral and Altai ranges, the Himalayas, the Abyssinian mountains, the 

 Andes, Cordilleras, the mountains of Japan and the Asiatic islands. 



The cretinic degeneration is, however, by no means confined to the 



