THE CRETINIC DEGENERATION 447 



escaping. It is likely that the ice was derived from a goitrous fresh water 

 source. 



Of military epidemics there have been many reported in the older 

 literature. It is a striking fact that in spite of the millions of men en- 

 gaged in the recent World War, such outbreaks scarcely seem to have 

 occurred. This contrast is probably ascribable to the infinitely improved 

 hygienic surroundings and food supply of soldiers in the twentieth than 

 in the eighteenth or even nineteenth century. 



Of the many military outbreaks of goiter, an account of one of the 

 most interesting must here suffice. The development of goiter in an 

 infantry regiment sent to Nancy in 1783 was reported by Valentin and 

 cited by Lebert and others. Goiter is rnildly endemic in this locality. 

 During the winter of 1783, 38 men developed goiters. The number 

 affected gradually increased until, in 1786, 425 had acquired the disease. 

 In 1787 the epidemic diminished, the number of cases falling to 257 and in 

 1788 to 132 cases. It terminated in 1789 with 43 cases. The private 

 soldiers alone were affected, the officers being exempt though quartered 

 in the same barracks. The immunity of the officers to the disease has 

 been ascribed to the greater opportunity for wine drinking, therefore less 

 water intake on the part of the officers; but also, according to Taussig 

 and Kutschera, to the more isolated quarters and consequent less close 

 and frequent contact with goitrous individuals. 



The observation of Cardinal Billiet in the normal school of Albertville 

 is quoted by H. Bircher. In a girls' school to which use the building was 

 put for twenty years previous to 1860, goiter was unknown. During this 

 year improvements were made and a normal school instituted, the building 

 debris being thrown carelessly near the well. From twenty-five to thirty 

 per cent of the pupils became goitrous within a short period. When rain- 

 water instead of the well-water was used for drinking purposes, the goiters 

 promptly disappeared. 



Etiology 



Influence of Heredity. Congenital goiter is the most frequent heredi- 

 tary manifestation of the cretinic degeneration though it is much less fre- 

 quent than the acquired, the ratio being about 1:17 for Switzerland (Dem- 

 me) . The frequency varies in various districts, however, and directly with 

 the gravity of the disease. In severely affected Himalayan villages as high 

 as sixty per cent of breast-fed children show congenital goiters. On the 

 other hand, cretinism in the offspring is usually preceded by goiter in the 

 parent. Ninety-six per cent of the mothers and forty per cent of the 

 fathers of cretins had goiter (McCarrison). This writer also ascribes 

 mental shock, worry and depression, also disease of the mother as etio- 

 logically important. With regard to the etiologic role played by disease, 



