284 



THE DUCTLESS GLANDS 



specimen of thyroid reaction as a phase of this cycle and not as 

 an entity either anatomically or physiologically. 



Iodine is usually recommended for goitre, especially in its 

 early stages. 



2. Endemic Cretinism 



The precise relationship between goitre and cretinism has 



been the subject of 

 much discussion and 

 speculation. 



The subject has re- 

 cently been reinvesti- 

 gated by McCarrison in 

 the Chitral and Gilgit 

 Valleys. He concludes 

 that the degree to 

 v which cretinism is 



associated with goitre 

 is determined by the 

 age of the endemic, 

 and varies directly with 

 the extent to which the 

 latter disease prevails 

 among the adult popu- 

 lation. Cretinism is 

 rarely, if ever, due to 

 the development of a 

 goitre in the individual. 

 The thyroid enlarge- 

 ment is, or may be, an 

 effect ; it is not the 

 cause of the disease. 

 Defective thyroid func- 

 tion in the mother is 

 the essential factor in the production of cretinism. 



Cretinism is due to the action of toxic agents, notably that 

 of endemic goitre, on the developing thyroid of the unborn 

 child. The thyroid defect is congenital, but it may remain 

 latent pending its manifestation through the impulse of some 

 accidental circumstance. 



The symptoms of cretinism have been so often and so fully 



FIG. 83. Cretin before treatment. Age 28 

 (June, 1895). Height 34 in. (From Murray.) 



