THE CRETINIC DEGENERATION 457 



amelioration of intestinal toxemia from whatsoever cause, the antiseptic 

 action of thymol, etc. 



A critical survey of the accumulated evidence renders it difficult to 

 avoid acceptance of the bacterial theory of McCarrison. True it is, how- 

 ever, that still many facts require confirmation and further elucidation. 

 In particular more exact work is required on the nature of the bacteria 

 and their toxins capable of producing goiter and cretinism. Also further 

 corroboration and elaboration of therapeutic experiments are necessary. 



McCarrison rather firmly adheres to the "unitarian" conception of 

 the pathogenesis of the disease so far as the thyroid is concerned, inas- 

 much as he denies any fundamental difference between endemic or sporadic 

 goiter and cretinism. He stands, however, in an isolated and not easily 

 defensible position in regarding the disease as one of -"the thyroid para- 

 thyroid apparatus.' 7 It would seem to the present writer that the bril- 

 liant results of his researches could be better applied in affording an 

 adequate explanation for the "dualistic" conception of the disease (see 

 above) which accepts a noxus affecting all organs and tissues of the body in 

 addition to its early and local effect upon the thyroid gland with resulting 

 hypothyroid symptoms. Indeed, the stumbling-block in the path of ac- 

 ceptance of this conception has remained just the uncertainty as to the 

 causative agent involved. This doubt McCarrison has largely removed. 

 The acceptance of an intestinal toxemia acting slowly upon all organs and 

 tissues, particularly upon the sensitive endocrin and nervous systems, would 

 adequately account for not only the hypothyroid symptoms, but also 

 the early and frequent presence of deaf-mutism, as well as the prominence 

 of idiocy and cardiac symptoms in the cretinic degeneration. The funda- 

 mental differences from hypothyroidism shown by the cretinic degenera- 

 tion as emphasized by European writers, viz., the usual development of 

 the symptoms at a later date, the irregularity of the retardation of the 

 ossification, the absence of parallelism between thyroid pathology and the 

 general symptomatology, also a number of other peculiar characteristics, 

 can be clearly understood with the aid of the bacterial theory. In view 

 of the pathologic findings in the pituitary and other endocrin glands as 

 well as the association of endemic cretinism with endemic tetany, etc., and 

 their existence at times in combination in the same individual, it seems 

 indeed possible that the thyroid is not the only member of the endocrin 

 system involved by the disease. This can be interpreted as further evi- 

 dence supporting the bacterial theory of the cretinic degeneration. 



General Summary of the Etiology of the Cretinic Degeneration 



The influence of heredity in the development of the disease is marked. 

 The offspring of parents affected with the cretinic degeneration, partic- 

 ularly goiter, are most liable to contract the disease. 



