THE CRETINIC DEGENERATION 453 



Though it is generally true that cretinic degeneration occurs with 

 predilection on such limestone formations as indicated, yet very many 

 unaffected communities and regions are underlain by the same rock strata. 

 Moreover, it is now known through the researches of Hesse, Schittenhelm 

 and Weichardt that Archean and eruptive strata are by no means free 

 of goiter, which definitely disproves the hydrotelluric theory as no organic 

 material whatsoever can be washed out of such rocks. 



The consensus of present authority discredits the geological hypoth- 

 esis of Bircher, though he and others brought together much evidence in 

 its support. There remains, however, an explanation to be sought for 

 the frequency of occurrence of the cretinic degeneration upon the Paleozoic 

 and other limestone strata. McCarrison (a) tersely summarizes the mod- 

 ern viewpoint of this question when he states: 



"The explanation of the frequent association of goiter with limestone 

 rocks is that they are amongst the most porous, as well as the most widely 

 distributed, of all geological formations. They are thus amongst the most 

 freely cultivated and inhabited, and their porosity favors the passage 

 of the excitants of the disease to unprotected water-supplies. Waters de- 

 rived from such rocks may contain an excessive quantity of lime, the in- 

 gestion of which, while not actually the cause of goiter, throws an ad- 

 ditional burden on the functional resources of the thyroid gland. The 

 presence in the soil of decaying vegetable or animal matter may convert 

 any soil, no matter what its geological origin, into a suitable habitat 

 for the coniagium vivum of the disease. A manure heap or a cess-pit, 

 for example, will be far more effective in this direction than the remains 

 of extinct flora or fauna." 



The Plutonian Theory of Repin is closely associated with the fore- 

 going. Repin assumes the important characteristics of mineral waters 

 to be their general effect upon metabolism, their emergence from deep 

 fractures of the earth's crust, their increased radioactivity and their lime 

 content. This author believes goitrigenous waters to be always such 

 natural or eruptive waters and weaves a complex hypothesis based upon 

 these views. 



This ingenious speculation is disproven by many facts now well 

 known, for example, the fact that soft water, even rain water, may pro- 

 duce goiter under some circumstances . (McCarrison). This fact also 

 strongly militates against Bircher's hydrotelluric theory. It may be added 

 that Hesse has disproven any etiologic connection between radioactive 

 waters and the cretinic degeneration. 



The Organic Theory of Goiter. Of recent years, attention has been 

 more and more directed toward the possibility of an organic etiology. 



Lustig and Carle, the Swiss Goiter Commission, E. Bircher (r), 



