444 NELSON W. JANNEY 



attributable conservatively to endemic cretinism which during ten years 

 would amount to nearly one-fourth of the Swiss army (Oswald). In 

 1883 among'a total population of 9,565,038 in the Italian provinces Pied- 

 mont, Lombardy and Venetia, there were 12,882 cretins and 128,730 

 goitrous (Ewald). In severely affected districts, such as Murau in 

 Steiermark, Austria, 1 per cent of inhabitants are cretins (Ewald). In 

 France, according to Baillarger's statistics (1873), 370,403 goitrous and 

 lL>0,700 cretinous inhabitants existed in a population of about thirty-six 

 millions. McCarrison states, "In some Himalayan villages the disease 

 is so common that it is difficult to find a man, woman or child not suffering 

 from the deformity (i. e., goiter). In India at the present time not less 

 than five million persons are afflicted with goiter, while half a million is 

 a low estimate of the numbers who suffer from its congenital manifesta- 

 tions." The disease is common in England in Hampshire, also in Sussex, 

 and so frequently met with in Derbyshire as to give to goiter the nickname 

 of "Derbyshire neck." 



For the United States, little statistical information is available which 

 is due to the mildness of the cretinic degeneration in this country. Sub- 

 stantiated cases of endemic cretinism the writer has not found reported in 

 the literature, while the endemic goiters are usually small, often escaping 

 popular observation. Dock has reported an incidence of two to three goiter 

 per 1,000 and 10 per cent among young women. This embodies simple goi- 

 ter of various causation. Munson reported up to 2.36 per cent in the Ameri- 

 can Indian population. Adami, Marine (a), Osier (a) report the fre- 

 quency of goiter in the Great Lakes region. Adami mentions its great 

 prevalence in certain French Canadian villages. In West Virginia it is 

 frequent, Clark and Pierce in 1913 finding 1,234 cases of goiter among 

 13,S3fi school children. In Virginia 12.7 per cent (817) cases were found 

 among f>,432 goitrous public school children, the incidence in Carroll 

 County, Va., being 23 per cent. No cases of cretinism were found in either 

 state. Negroes were also affected severely. In the colored high school at 

 Charleston, W. Va., every girl of the senior class suffered from goiter. 

 Less than one-tenth of one per cent of goiter in this report of the disease in 

 the Virginias was found to occur in boys. In certain of the Western states, 

 particularly Nevada, California, Oregon and Washington, small goiters 

 are quite common according to the U. S. Army statistics of W. J. Kerr 

 among 21,000 troops. Twenty-one per cent showed definite thyroid en- 

 largement, but among them were included cases showing thyrotoxic 

 symptoms. 



The world's incidence of cretinic degeneration is in all probability 

 generally decreasing in indirect ratio with the improvement of water 

 supply and hygiene. This fact is difficult to establish statistically. 



In severely affected localities and countries, the presence of large 

 numbers of helpless endemic cretins, idiots and deaf-mutes entails the 



