MYXEDEMA AND CRETINISM 491 



satisfactory evidence, particularly in view of the abundant 

 iodin content of many goiters. Epidemics of goiter presum- 

 ably are the results of an infection with some unknown organ- 

 ism, and possibly the endemic form has a similar cause. There 

 is much evidence, in any event, that whatever the cause of 

 goiter may be, it often is related to the drinking-water. 1 Very 

 probably the causes of colloid goiter and parenchymatous goiter 

 will be found to be different from each other and from the 

 causes of cystic and adenomatous goiters. 



MYXEDEMA AND CRETINISM 



These conditions depend upon a deficiency of thyroid secretion, 

 whether from operative procedure or from pathological altera- 

 tions in the organ. Consequently we find evidences of a 

 decreased proteid metabolism, the urine containing a diminished 

 quantity of nitrogen, especially in the form of urea, while 

 ammonia and other forms of nitrogen are relatively excessive. 

 The temperature is usually subnormal. Fat and carbohydrate 

 metabolism seem not to be proportionately affected, 2 and hence 

 the elimination of CO 2 is relatively high as compared to 

 the nitrogen elimination. Gastro-intestinal disturbances are 

 common, with resulting increase in the amount of indican and 

 ethereal sulphates in the urine. Whether from this cause or 

 from deep-seated metabolic anomalies, there is a decided anemia, 

 and the ability of the corpuscles to combine with oxygen seems 

 to be decreased, so that the arterial blood may contain less 

 oxygen than normal venous blood. It is impossible to say 

 whether the failure of growth and development of the young 

 (cretinism), and the mental and physical torpidity of the adult, 

 are due to an autointoxication from products of intermediary 

 metabolism which accumulate because of the failure of the 

 thyroid to furnish the " stimulus " necessary for their complete 

 destruction, or to a lack of some essential action of the thyroid 

 secretion upon the nervous tissues and the growing cells them- 

 selves. Administration of thyroid extract to cretinoid children 

 causes retention of nitrogen and phosphorus, but more strikingly 

 of calcium. 3 



The myxedematous change in the connective tissues is in 

 the nature of a reversion to the fetal type of tissue, and sug- 

 gests that the thyroid secretion is necessary for proper cell 



1 See de Quervain, Mitt. a. d. Grenzgeb. Med. u. Chir., 1905 (15), 297. 



2 Rarely myxedema and diabetes have been observed conjointly (see 

 Strasser, Jour. Amer. Med. Assoc., 1906 (44), 765). 



8 See Hougardy and Langstein, Zeit. f. Kinderheilk., 1905 (61), 633. 



