Cretinism may be defined as an arrest of somatic and psychic development dependent generally upon a goiter, and more rarely upon simple atrophy of the thyroid gland.

1 Briquet. Valeur comparee des medications thyroidiennes. Presse medic, 1902, No. 74.

The affection occurs endemically in mountainous regions, such as the Alps, the Rocky Mountains, the high plateaus of Himalaya, Black Forest, etc., and sporadically in most regions. Its etiology is not well known. Numerous factors are said to be capable of causing it: atmospheric humidity; certain geological compositions of the soil (cretinism occurs frequently in countries where the soil is composed of schistose clay or of streaked sandstone); poor quality of the water, which in the endemic sections is poorly aerated, deprived of iodine, and charged with calcium and magnesium salts; want; heredity.

All these causes, the influence of which should be kept in view, probably only prepare the soil for the action of some specific agent still unknown. According to the opinion of Griesinger, "endemic goiter and cretinism are specific diseases produced by a toxic cause of miasmatic nature."

The symptoms of cretinism usually appear in early childhood. Sometimes the onset is acute, so that the destruction of the gland is accomplished in a few days. Such was the case reported by Shields,1 in which an acute thyroiditis caused the destruction of the thyroid gland and resulted in cretinism.

Much more frequently the process is insidious, and it is impossible to ascertain the exact date of onset.

The size of the goiter is variable. The swelling may be slight, scarcely perceptible, or so enormous as to completely disable the patient. Resulting usually from a degeneration of the thyroid gland, it becomes evident at about the sixth or eighth year of age and increases up to the time of puberty or even later.

Simple atrophy of the gland is much less frequent and is seen chiefly in sporadic cases.

Physically the cretin exhibits, in addition to the changes in the thyroid gland, the following symptoms: the stature is below the normal; the face is pale, puffed, or marked precociously with senile wrinkles; the pilous system is poorly developed; the mucous membranes are pale, anaemic, and thickened; the teeth are abnormal in shape and implantation and subject to caries; puberty is retarded or even absent, and the cretin may remain infantile all his life.

1A Case of Cretinism Following an Attack of Acute Thyroiditis. New York Med. Jour., Oct. 1, 1898.

Psychically we encounter all degrees of idiocy and imbecility. It seems, however, that the cretin is less impulsive, more manageable, and more capable of emotional activity than the ordinary idiot or imbecile.1

The brains of cretins present no known specific lesions; asymmetry and various malformations of the hemispheres are frequent.

The treatment2 consists in thyroid medication, the results of which are the more perceptible the earlier it is instituted.