THE CRETINIC DEGENERATION 467 



dividuals may walk on their toes. The lower limbs are most often the 

 seat of the spastic diplegia. Sensitivity of the skin is present. The 

 upper limbs may show tetanoid movements and the characteristic flexed 

 thumb of tetany. Myxedema may be present. Improvement occurred on 

 thyroid therapy. 



Deaf-mutism is disastrously prevalent in association with cretinic 

 degeneration. This seems particularly true of Switzerland and Austria. 

 In the former country the ratio, according to St. Lager, is 5 cretins to 

 4 deaf-mutes. Bircher who has given this subject special attention claims 

 that 80 per cent of all deaf-mutes in Switzerland are ascribable to cretinic 

 degeneration. In Austria, Scholz found 61 per cent of his series hard 

 of hearing or deaf-mutes. In India the proportion is greater, 87 per 

 cent (McCarrison). Where endemic cretinism flourishes, endemic deaf- 

 mutism is to be found and there only. This holds true so universally as 

 to clearly indicate that both are but manifestations of the one disease, the 

 cretinic degeneration. This interrelationship and the great frequency 

 of deaf-mutism are clearly shown by the Austrian Sanitary statistics of 

 1900. In the entire country there were together 17,286 cretins and 27,- 

 567 deaf-mutes; 64 cretins and 100 deaf-mutes per 100,000 inhabitants. 

 However, in the regions where cretins were most numerous, deaf-mutes 

 were present in like ratio. Thus Salzberg, Steiermark and Carinthia were 

 found to have respectively 179, 175 and 226 cretins, and 133, 139 and 182 

 deaf-mutes per 100,000. Conversely in Dalmatia, Istria and Bukovina 

 there were enumerated only 7, 42, 32 cretins and 66, 96, 85 deaf-mutes per 

 100,000. 



Deaf-mutism may exhibit itself as practically the only stigma of this 

 degenerative disease. Again, it may be associated with hypothyroid symp- 

 toms and may, at least to a large degree, be dependent upon loss of thyroid 

 function. The intelligence may at times be remarkably good in the pres- 

 ence of deaf-mutism. Usually the contrary holds true. Speech, even when 

 no pathological defect is present, remains undeveloped if no hearing be 

 possible. On the other hand, hearing may be excellent but intelligence 

 and speech deficient. 



Goiter Heart. Cardiovascular disturbances are known to be quite 

 frequent among endemic cretins and goitrous individuals. According to 

 Schranz, who studied several hundred goitrous school children and adults, 

 also over 200 autopsy records in Innsbruck, 23 per cent of the goitrous 

 children and 49 per cent of the goitrous adults were found to have cardiac 

 lesions associated with goiters. Cases of valvular- heart disease were 

 omitted. In spite of all criticism which tends to reduce the number of these 

 cardiac cases, Schranz's work definitely established the prevalence of 

 cardiac disease in the cretinic degeneration. 



In older writings this coincidence of cardiac disturbances with goiter 

 has been frequently the subject of clinical comment. The term "goiter- 



