THE CBETIOTC DEGENERATION 463 



degeneration. Langhans reported in a cretin of 24 years the testes and 

 epididymus of child-like size, spermatozoa in diminished numbers or lack- 

 ing altogether. 



The Osseous System. The retardation in development of the skeleton 

 resembles in the main that of sporadic hypothyroidism but there are cer- 

 tain minor differences. The epiphyseal closures are markedly delayed 

 but not to such a great degree as in severe hypothyroidism of sporadic 

 nature. (Langhans, von Wyss, etc.) But according to Breus and Kolisko, 

 also E. Bircher (&), the retardation of epiphyseal union is only exhibited 

 during the years of normal growth. After the thirtieth year the epiphyses 

 are closed in most cases. In this we have a fundamental difference from 

 sporadic hypothyroidism in which the , untreated cases of severe type 

 exhibit open epiphyses until advanced age. Later authors emphasize the 

 irregularity of the ossification and its retardation. In certain bones these 

 changes are marked, others escape again in contrast to non-endemic 

 cretinism. It is also to be remarked that in the early years of life, the 

 retardation of bone formation is very slight on account of a certain period 

 of exposure seemingly necessary for development of the disease. This 

 behavior Diet'erle (&) contrasts with sporadic athyreosis in which wide 

 open fontanelles and epiphyses persist from babyhood. Cranial meas- 

 urements have been carried out by v. Scholz (6), E. Bircher, Hofler, B. 

 Niepce, et al. The skull of endemic cretins is characterized by the short 

 basis cranii, the great breadth of the interorbital septum and the ab- 

 normally low Superior maxillary bone. The horizontal circumference is 

 normal but the skull is both brachycephalic and platycephalic. Many 

 of the older observations on the cretin skeleton are of little value on account 

 of confusion with other growth anomalies. As an example may be men- 

 tioned the classical error of Virchow, who accredited the cretin skull with 

 an early tendency to synostosis, having mistakenly so described cases 

 of chondrodystrophy. From a study of the literature striking differ- 

 ences in the cranial conformation of endemic and sporadic cretinism do not, 

 however, seem to be apparent. 



The metabolism of endemic cretins has been little studied as yet. It 

 presents an attractive field for research. What little is known suggests a 

 similarity to that of sporadic hypothyroidism. Scholz' s (a) earlier re- 

 searches were carried out in part with questionable methods but indicate a 

 lowered excretion of protein and protein metabolites including uric acid, 

 creatinin, urea, ammonia and sulphuric acid. Scholz states that an in- 

 creased protein elimination is not so easily obtained through the adminis- 

 tration of thyroid substance in endemic cretinism as in myxedema. This 

 may be explained etiologically by the fact that not all the pathological 

 changes in the cretinic degeneration are definitely describable to a defec- 

 tively functionating thyroid gland. It would seem to the author that a 

 study of the basal metabolism might be especially applicable in differen- 



