576 INTERNAL SECRETION 



theories were prevalent ; it was supposed by some that the gland 

 by its relationship to the larynx supported that structure and 

 strengthened the voice ; others held that the thyroid body regu- 

 lated the supply of blood to the brain. These are examples of 

 the effect of anatomical reasoning. Valuable facts, on the other 

 hand, have been learnt by the study of the changes produced in 

 man and animals by disease or removal of the gland. 



Cretinism is a peculiar disease, in most cases of congenital 

 origin and confined to certain districts of a country. The patient 

 presents markedly abnormal features. His stature is stunted ; a 

 man of twenty years may be less than three feet high ; the body 

 is deformed ; the head is broad from ear to ear ; the nose is 

 flattened, the bridge being absent ; the mouth is large and open ; 

 the skin dry, wrinkled, and of an earthy colour ; the hair is coarse, 

 sparse, and dry. The neck and shoulders are swollen out by 

 large pads of fatty tissue ; the chest is narrow, the abdomen large 

 and pendulous. The limbs are short and misshapen. The mental 

 condition is worse than that of an ordinary idiot, the creature 

 being frequently unable to speak, and uttering only a strange 

 cry or a peculiar chuckle. 



Such is the spectacle presented by a cretin, and we must now 

 see how these changes are related to the thyroid gland. In many 

 of these cretins the thyroid gland is absent ; in others it is en- 

 larged by disease. Moreover, it is found that these subjects are 

 in many cases born of parents suffering from disease of the thyroid 

 gland. Men, and especially women living in certain districts, 

 such as some valleys in Switzerland, suffer from goitre, an en- 

 largement of the thyroid gland due to causes as yet unknown. 

 The symptoms of this disease are chiefly due to the pressure exerted 

 by the enlarged gland upon the trachea, oesophagus, blood-vessels 

 and nerves of the neck ; there thus arise difficulty of breathing 

 and swallowing, disturbances in the circulation and the beating 

 of the heart. Such symptoms would probably be removed by 

 extirpation of the gland. Kocher of Berne accordingly excised 

 the gland of patients suffering from goitre, and the immediate 

 effect was most satisfactory. The symptoms of the disease dis- 

 appeared. Later, however, the patients passed into a condition 

 of cachexia, now known as operative myxoedema or cachexia 

 strumipriva ; the condition resembled cretinism, but there were 

 naturally many modifications, for the growth of the body having 



