THE CRETINIC DEGENERATION 461 



careous, amyloid, parenchymatous and fatty. Hemorrhage and cyst forma- 

 tion may occur. These changes may or may not be accompanied by the 

 systemic effects of thyroid subfunction. 



b. Atrophic Thyroid Lesions in the Cretinic Degeneration. The 

 thyroid gland is occasionally reported absent in endemic cretinism. 

 (Kocher (&), Langhans (c).) Wagner von Jauregg rightfully raises the 

 point whether or no sporadic athyreosis occurring in endemic cretin areas 

 might not account for such absent thyroid glands, and also points out that 

 the absence of the thyroid in endemic cretins has not been proven beyond 

 the possibility of objection, i. e., by complete histological examination of 

 the cervical tissues. 



Hanau, De Coulon, Bayon, S. Getzowa, Langnans, E. Bircher (d), Mc- 

 Carrison et al. have examined the thyroid historically. The lesions 

 found include great decrease in the normal acini fibrous tissue overgrowth, 

 some of which may show hyaline degeneration (Bayon, Getzowa). Schlag- 

 enhaufer and von Wagner carefully studied the thyroid of an endemic 

 cretin four years of age. Macroscopically the gland was normal. The 

 glandular epithelium showed, however, severe lesions. The cells were 

 of irregular size and poorly demarcated, the protoplasm stained irregu- 

 larly, the nuclear membrane was thickened, the nuclei swollen and various- 

 ly degenerated. 



Other ductless glands may be affected in endemic cretinism. Though 

 usually reported negative (E. Bircher, Getzowa, Scholz), the parathy- 

 roids were not found in a case of nervous cretinism showing tetany (Mc- 

 Carrison (a.) ). The close association of endemic tetany to endemic cretin- 

 ism would also suggest the liability of both the thyroid and parathyroid 

 being affected by the same toxic agent. The pituitary gland according 

 to Shonemann is the seat of pathologic changes in 95 of 112 cases 

 without goiter. All but one of the goitrous cases had abnormal pituitary 

 glands. Among the histologic changes were connective tissue overgrowth, 

 hyaline degeneration, colloid formation, vascular and chromophilic hyper- 

 plasias. De Coulon reported macroscopic hypertrophy but diminution of 

 the glandular tissue. B. and A. Niepce report similar lesions. 



The skin is less frequently myxedemic than in sporadic cretinism 

 though McCarrison's Indian cretins often exhibit swollen integuments. 

 There are but fragmentary observations in the literature of the character 

 of the histologic lesions. Bernard and Wagner v. Jauregg found no char- 

 acteristic changes. 



The Central Nervous System is attacked with characteristic severity. 

 Findings at autopsy include thickened and adherent meninges, inequality 

 in size of the hemispheres, disproportionate smallness of the cerebellum, 

 imperfect convolutions, preponderance of the gray matter, internal hydro- 

 cephalus, increased resistance on section. Typical histological findings 

 have not been reported. Extensive cord changes were noted by McCar- 



