462 NELSON W. JANNEY 



rison in his autopsy of an endemic cretin with spastic diplegia. Addi- 

 tional pathological study of endemic cretinism is indicated. 



Marked disturbances in the special senses are frequently met with. 

 Speech may be affected rarely per se, more frequently in combination 

 with deaf-mutism where it may be secondary to the failure of hearing 

 spoken language. The power of articulation may be inhibited through 

 failure in development of the cortical center or higher psychic centers 

 in endemic idiocy (Scholz and Zingerle), or peripherally through thick- 

 ening of the vocal cords and pharyngeal anomalies. 



With regard to the acoustic organs, Falta (a) has succinctly stated the 

 present status of knowledge and is therefore quoted as follows : 



"The statements as to the functional disturbances or the pathologico- 

 anatomical findings in the deaf cretins and in the endemic deaf-mutes 

 diverge greatly. Hammerschlag, whom we have to thank for the first 

 exact investigations, found on the one hand alterations in the peripheral 

 hearing apparatus, and on the other only disturbance of the perception of 

 sound, as also found Scholz, Eroschel, and others. Further, there was 

 found in endemic cretinism incomplete ossification of the stapes, inhibi- 

 tion of development of the epithelial cells in the ductus cochlearis (Haber- 

 mann, Alexander), shortening of the base of the skull and thereby dis- 

 turbance in the development of the organ of hearing (Danzinger, Bircher), 

 incomplete ossification of the organ of hearing with hyperostotic growths 

 at other places (Moos and Steinbriigge). Anomalies of the malleus 

 (Nager), myxedematous thickening of the tympanic mucous membrane, 

 etc., have been regarded as the cause of hardness-of-hearing. Recently, 

 E. Bircher has strenuously criticised a portion of these findings or their 

 significance. To-day we may safely assume that we may ascribe great 

 importance to the degeneration in the cortical centers or the developmental 

 inhibitions in the cortical centers, and that the different alterations are 

 directly elicited by the goiter noxus and are coordinated with an insuffi- 

 ciency of the thyroid, which finally sets in (Pineles)." 



It should, however, be mentioned that B. Niepce found definite patho- 

 logical changes in the acoustic nerve in several cases. 



The internal organs have been little studied. 



The cardiovascular system may undergo atheromatous changes with 

 cardiac lesions. (See section Symptomatology.) 



tfe..rual rehinlal ion corresponds in general to that observed in sporadic 

 hypothyroidism. In lii>ht cases the power of reproduction may be retained. 

 The libido se.rwilis is weak or absent in the severely affected, whose repro- 

 ductive organs may remain infantile. Cretins seldom conceive. When 

 tins docs occur the fetuses are born dead (E. Bircher, Eppinger). Mc- 

 Oarrison has made the same observation in the case of goitrous goats. The 

 triiuile iienerative organs show developmental retardation and microcystic 



